Etanercept (Enbrel)

This is a fusion protein. This is a TNF-alpha receptor fused onto human IgG. It acts by inhibiting TNF-alpha activity.

It is used for rheumatoid arthritis,juvenile rheumatoid arthritis as well as psoriatic arthritis. This shows good activity against psoriatic arthritis with eighty-seven percent of patients in one study showing significant improvement compared to twenty-three percent in the placebo group. In patients with skin psoriasis about one quarter showed seventy-five percent improvement in their PASI scores.

Dosage

Etanercept is given as a 25 mg twice weekly dose injected subcutaneously at home. This drug should be avoided in patients with a history of multiple sclerosis.

Side Effects

The common side effect is at the site of injection. These reactions are usually mild to moderate and diminish in frequency after the first month of treatment. Redness, itching, pain and swelling were described. There is a slight increase in the incidence of upper respiratory tract infections. It should not be used in those with congestive heart disease. There is a risk of re-activating tuberculosis so therefore it is avoided in individuals with positive tuberculin skin tests. There is a small series of patients who have developed signs of drug induced systemic lupus. It is possible that this drug may unmask multiple sclerosis.

Drug Interactions

This drug has been used in combination with both cyclosporine and methotrexate.

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