II. Indications
- Refractory Rheumatoid Arthritis
- Combined with Methotrexate and other DMARDs
- Corticosteroid sparing in agents
- Juvenile Rheumatoid Arthritis
- Psoriatic Arthritis
- Ankylosing Spondylitis
III. Contraindications
IV. Mechanism
- See Tumor Necrosis Factor Inhibitor
- Etanercept is a recombinant soluble Antibody against human Tumor Necrosis Factor alpha
- Etanercept has a unique structure among modern TNF Inhibitors which are primarily monoclonal antibodies
- Etanercept is a dimeric fusion Protein (2 components)
- Extracellular Ligand-binding region of TNF receptor
- Fc domain of Immunoglobulin G (IgG)
- Etanercept binds circulating TNF and inhibits TNF binding to TNF cell surface receptors
- Blocks TNF-mediated inflammatory activity
V. Medications
- Etanercept (Enbrel)
- Original prototype drug with release in 1998 for Rheumatoid Arthritis, with expanding indications since
- Multiple biosimilar agents (Erelzi, Eticovo) are available
- However, Biosimilars are not considered interchangeable (consistently use same agent)
VI. Dosing
- See Monoclonal Antibody for preparation for use
- Background
- Injection sites include thigh, Abdomen or upper, outer arm (rotate injection sites)
- Available as a Preloaded vial or syringe
- Refrigerate and protect from light
- Stable at room Temperature for up to 14 days
- Allow to warm to room Temperature for 15 to 30 minutes before injection (decreased pain)
-
Rheumatoid Arthritis, Psoriatic Arthritis or Ankylosing Spondylitis
- Inject 50 mg SQ weekly
- Plaque Psoriasis
- Start 50 mg SQ twice weekly for 3 months
- Next 50 mg SQ weekly
- Child (weight <63 kg)
- Indicated in Juvenile Idiopathic Arthritis (age >2 years) and plaque Psoriasis (age >4 years)
- Use adult dosing for weight >=63 kg
- Inject 0.8 mg/kg SQ weekly
VII. Precautions
- See TNF Inhibitor
- TNF Inhibitors predispose to serious infections and malignancy
- Prepare for TNF Inhibitor use with infection screening (e.g. Tuberculosis) and Immunizations
VIII. Efficacy
- Rapid onset and very effective
- Arrests XRay progression
- Good synergistic effect with Methotrexate
IX. Adverse Effects
- See Tumor Necrosis Factor Inhibitor
- Potential risk of infection
- No significant adverse effects
X. Safety
- Considered safe in Lactation
- Pregnancy
- May use in pregnancy (any trimester) if indicated and benefit outweighs risk
- Fetal exposure risk increases after 20 weeks
XI. Pharmacokinetics
- Metabolism by proteolysis
XII. Monitoring
- Consider following Complete Blood Count
XIII. Resources
- Etanercept Injection Solution (DailyMed)
XIV. References
- (2023) Biologics for Crohn's Disease, Presc Lett, #390826
- (2023) Drugs for Inflammatory Bowel Disease, Med Lett Drug Ther 65: 105-12
- Bathon (2000) N Engl J Med 343:1586-93 [PubMed]
- Weinblatt (1999) N Engl J Med 340: 253-9 [PubMed]
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Related Studies
| enbrel (on 7/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ENBREL 25 MG/0.5 ML SYRINGE | $1,597.43 per ml | |
| ENBREL 50 MG/ML MINI CARTRIDGE | $1,596.93 per ml | |
| ENBREL 50 MG/ML SURECLICK | $1,599.63 per ml | |
| ENBREL 50 MG/ML SYRINGE | $1,596.90 per ml | |