Psoriasis is a chronic inflammatory disease affecting 2% to 3% of the population 
in Western countries. Psoriasis is associated with limited quality of life, 
cardiovascular disease, and depression. The approval of injectable biological 
agents has revolutionized the management of moderate to severe psoriasis. 
Adalimumab is a human monoclonal antibody against tumor necrosis factor (TNF) 
alpha approved for moderate-to-severe plaque-type psoriasis and psoriatic 
arthritis (PsA). This systematic review summarizes the evidence concerning the 
efficacy, clinical effectiveness, safety, and cost-effectiveness of adalimumab 
in the treatment of psoriasis. Five randomized controlled trials demonstrated 
the efficacy of adalimumab in moderate-to-severe plaque-type psoriasis and PsA 
with PASI-75 response rates of 53% to 80% and ACR-20 response rates of 39% to 
58% after 12 to 16 weeks of treatment. In clinical practice patients who have 
not responded to one TNF antagonist may respond to another TNF antagonist. 
Adalimumab has similar or better cost-effectiveness than other biologics, but is 
less efficient than methotrexate and cyclosporine. Adalimumab is generally well 
tolerated. Patients should be evaluated for active/latent tuberculosis, serious 
infections, and other contraindications prior to initiation of adalimumab 
therapy. Future studies should investigate the comparative efficacy of 
adalimumab and other biologic and prebiologic agents. Recently established 
registries will yield additional data on the effectiveness and long-term safety 
of adalimumab.