Tumour necrosis factor (TNF) plays an important role in the pathogenesis of 
immune-mediated inflammatory diseases (IMIDs). TNF inhibition results in 
down-regulation of abnormal and progressive inflammatory processes, resulting in 
rapid and sustained clinical remission, improved quality of life and prevention 
of target organ damage. Adalimumab is the first fully human monoclonal antibody 
directed against TNF. In this article, we review the role and cost effectiveness 
of adalimumab in the treatment of IMIDs in adults and children. The efficacy and 
tolerability of adalimumab has been demonstrated in patients with a wide range 
of inflammatory conditions, leading to regulatory approval in rheumatoid 
arthritis (RA), psoriatic arthritis (PsA), plaque psoriasis, inflammatory bowel 
diseases (Crohn's disease, ulcerative colitis, paediatric Crohn's disease, and 
intestinal Behçet's disease), ankylosing spondylitis (AS), axial 
spondyloarthritis (SpA) and juvenile idiopathic arthritis. The major 
tolerability issues with adalimumab are class effects, such as injection site 
reactions and increased risk of infection and lymphoma. As with all anti-TNF 
agents, adalimumab is immunogenic, although less than infliximab, and some 
patients receiving long-term adalimumab will develop anti-drug antibodies, 
causing a loss of response. Comparisons of its clinical utility and cost 
effectiveness have shown it to be a valid treatment choice in a wide range of 
patients. Recent data from Italian economic studies show the cost effectiveness 
of adalimumab to be below the threshold value for health care interventions for 
most indications. In addition, analysis of indirect costs shows that adalimumab 
significantly reduces social costs associated with RA, PsA, AS, Crohn's disease 
and psoriasis. The fact that adalimumab has the widest range of approved 
indications, many often presenting together in the same patient due to the 
common pathogenesis, may further improve the utility of adalimumab. Current 
clinical evidence shows adalimumab to be a valuable resource in the management 
of IMIDs. Further research, designed to identify patients who may benefit most 
from this drug, will better highlight the role and cost-effectiveness of this 
versatile TNF inhibitor.