Etanercept (Enbrel®)

Etanercept (Enbrel®) is a fusion protein that is made by combining two proteins (TNF-a receptor is fused onto human immunoglobulin [IgG]). It acts by inhibiting TNF-a activity and is used to treat autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and psoriaisis. The TNF-a protein promotes inflammatory reactions that are designed to protect the body, however, when the immune system becomes overactive, healthy cells come under attack, resulting in inflammation of the skin and joints.

Etanercept is approved to treat moderate-to-severe long-term plaque psoriasis patients who are candidates for phototherapy or systemic therapy. It can be used alone or in combination with an immunosuppressant (e.g., methotrexate, cyclosporine). Its effectiveness has been shown in research studies for the prevention of progressive joint destruction, as seen in patients with rheumatoid arthritis or psoriatic arthritis.

How the treatment works

• Etanercept is a synthetic (man-made) protein that prevents TNF-a from activating the body's inflammatory responses. Blockade of this process by etanercept reduces inflammatory reactions and makes it very effective for treating psoriasis and other autoimmune diseases.
• Administered twice weekly by a subcutaneous (just under the skin) injection at home.
• Rotate injection sites (thigh, abdomen, or upper arm) to avoid irritation.
• If self-injecting, proper drug handling and storage is required.
• Available as sterile powder for reconstitution, pre-filled syringes and pen devices.

Advantages/Benefits

• Generally well-tolerated with mild to moderate side-effects that diminish after the first month
• Rapid improvement may be seen as early as 2-4 weeks after start of therapy
• Continuous use provides long-term control of psoriasis
• Effective for treating psoriatic arthritis

Disadvantages/Risks

• Common side-effects include injection site reactions (redness, itching, pain and swelling), cough and respiratory symptoms, infections, headaches
• Rare, but serious side-effects include allergic reactions, activation or re-activation of tuberculosis (TB), nerve problems (weakness, visual changes, etc.), heart problems (shortness of breath, leg swelling, etc.), pancytopenia (low blood counts for red cells, white cells, platelets), demyelinating disorders (diseases involving the central nervous system), and lymphomas (cancers involving certain white blood cells of the immune system), infections
• Not to be used in patients with pre-existing conditions, such as multiple sclerosis, central nervous system diseases, TB, hepatitis, congestive heart failure
• A small series of patients have developed signs of drug induced systemic lupus
• When treatment is discontinued, psoriasis returns in approximately 2 months
• Effectiveness may diminish over time

Comments & Suggestions

• Regular blood tests, chest x-rays and TB skin tests are required while undergoing therapy to monitor progress and side-effects.
• Immunization with 'live' vaccines during therapy is not recommended.
• Your doctor may decide to suspend treatment with etanercept due to the need for a vaccination or alternate with other psoriasis medications.
• If you are being treated with both etanercept and methotrexate (MTX), limit your alcohol consumption due to the potential for liver damage from MTX.