What is Etanercept?

Why is Etanercept prescribed?

What are the possible side-effects?

What are the risks?

What else should I know about Etanercept?

What is Etanercept?

Etanercept (trade name Enbrel) is a type of drug known as anti-TNF (anti-tumour necrosis factor). In people with rheumatoid arthritis and some other inflammatory diseases a protein called TNF is overproduced in the body, causing inflammation and damage to bones, cartilage and tissue. Anti-TNF drugs block the action of TNF and so reduce this inflammation. Etanercept is a type of drug known as a biological therapy.

What type of drug is etanercept (trade name Enbrel)?

Etanercept is an anti-TNF (anti-tumour necrosis factor) drug.

What does it do?

It blocks the action of TNF protein and so reduces inflammation.

What is it used for?

Etanercept is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and for young people with juvenile idiopathic arthritis (JIA).

How is it taken?

It is usually given as an injection under the skin (subcutaneous injection) once or twice a week.

Are there any side-effects?

The most common side-effects are reactions at the injection site (usually redness and sometimes itching), a blocked or runny nose, nausea, mild fever, headaches, dizziness, a rash and stomach problems. It can also make you more likely to develop infections.

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Why is Etanercept prescribed?

Etanercept is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and for young people with juvenile idiopathic arthritis (JIA).

Etanercept will only be prescribed if your arthritis is active. It will usually be used if you have already tried methotrexate or another disease-modifying anti-rheumatic drug (DMARD) such as sulfasalazine or hydroxychloroquine, or if you cannot use these drugs for any reason.

Slightly different restrictions may apply in the case of the other medical conditions, so you should discuss this with your doctor or rheumatology nurse.

Is there any reason I will not be prescribed etanercept?

Etanercept will not be prescribed if:

  • your arthritis is not active
  • you have an infection.

Your doctor may decide not to prescribe etanercept if:

  • you have had tuberculosis (TB) in the past
  • you have had other repeated or serious infections
  • you have multiple sclerosis (MS)
  • you have had cancer
  • you have or have had a serious heart condition
  • you have scarring of the lung tissue (lung fibrosis)
  • you are pregnant or breastfeeding

When and how do I take etanercept?

Etanercept is only available on prescription from a consultant rheumatologist. It is given once or twice a week by subcutaneous injection (an injection under the skin) and comes in a pre-filled ‘pen’ device or syringe.

You, your partner, or another member of your family can learn to give the injections. If this is not possible, you may be able to arrange for the injections to be given by your rheumatology nurse specialist or public health nurse.

Etanercept was originally only available as a drug called Enbrel. However, newer versions of biological therapies are becoming available, so you may be prescribed etanercept under a different name, such as Benepali or Erelzi. These drugs are known as biosimilars and work in a similar way.

How long does etanercept take to work?

If you respond to etanercept you will probably feel better in 2–12 weeks.

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What are the possible side-effects?

The most common side-effects of etanercept are:

  • a blocked or runny nose
  • nausea (feeling sick)
  • a mild fever
  • headaches
  • dizziness
  • a rash
  • stomach pain or indigestion
  • inflammation around the injection site.

Taking etanercept can make you more likely to develop infections. You should tell your doctor or rheumatology nurse straight away if you develop any of the following after starting etanercept:

  • a sore throat
  • a fever
  • any other symptoms of infection
  • unexplained bruising, bleeding or paleness
  • any other new symptoms or anything else that concerns you.

You should stop etanercept and see your doctor immediately if:

  • any of the symptoms listed above are severe
  • you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
  • you develop chickenpox or shingles.

Chickenpox and shingles can be severe in people who are on treatments that affect the immune system. You may need antiviral treatment, which your doctor will be able to prescribe. Your etanercept will be stopped if you do develop chickenpox or shingles and restarted when you are better.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

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What are the risks?

Anti-TNF drugs have been associated with some types of skin cancer. However, the link between the two is unclear. Skin cancers can often be treated successfully when diagnosed early. To be on the safe side, make sure to wear sunscreen and regularly check your skin for any new spots or changes to your freckles or moles.

Very rarely, people taking etanercept may develop a condition called drug-induced lupus. This is usually mild and can be diagnosed by a blood test. Symptoms include a rash, fever and increased joint pain. If you develop drug-induced lupus, etanercept will be stopped and the condition then usually disappears.

How can I reduce the risk of infection?

Because of its effects on the immune system, etanercept may make you more likely to pick up infections. You should try to avoid close contact with people with severe active infections, and visit the Food Safety Authority of Ireland website www.fsai.ie for information on reducing your risk of infection from foods.

Will it affect vaccinations?

If you are on etanercept it is recommended that you avoid live vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the vaccination with you.

If you are in your 70s and are offered shingles vaccination (Zostavax), you should discuss this with your rheumatology team. You may be advised to have the shingles vaccine before starting etanercept. Shingles vaccination is not recommended for people who are already on etanercept.

If possible, children should be brought up to date with their immunisations before starting etanercept therapy. Alternatively, children who require measles, mumps and rubella (MMR) immunisation may need to defer this while having treatment with etanercept.

Pneumovax (which gives protection against the most common cause of pneumonia) and yearly flu vaccines are safe and recommended.

Can I drink alcohol while on etanercept?

You can drink alcohol while on etanercept but should not exceed recommended amounts (1–2 units per day for women and 2–3 units per day for men). If you have psoriasis and you are also taking methotrexate, your doctor may advise lower limits (no more than 4 units per week) because methotrexate and alcohol can interact and damage your liver. Alcohol can also worsen psoriasis.

Does etanercept affect fertility or pregnancy?

If you are thinking of having a baby or if you become pregnant, you should discuss this with your rheumatologist. At present there is limited information on the use of etanercept during pregnancy and on how it might affect an unborn baby. Similarly, the effects of etanercept on men trying to father a child are uncertain.

Generally, it is recommended that men and women use contraception while on this drug. However, some women have used etanercept successfully during pregnancy to manage active disease and delivered healthy babies.

There may be an increased risk of infections in babies born to mothers using etanercept, particularly if it is taken during the third trimester of pregnancy. If this medication is required in the third trimester, you will be advised to delay the live vaccination schedule for your baby until they are 7 months old.

If you are also taking methotrexate this drug should be stopped three months before you try for a baby.

Does it affect breastfeeding?

Generally, it is recommended that you do not breastfeed if you want to re-start etanercept after pregnancy. However, limited information has shown that only small amounts of etanercept may pass into your breast milk, so you should discuss with your doctor whether to take etanercept whilst breastfeeding.

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What else should I know about Etanercept?

If you are being prescribed etanercept it is recommended that you carry a biological therapy alert card, which you can get from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on etanercept and that you are therefore at risk of its side-effects, including infections.

The pre-filled syringes and pens should be stored in a fridge at 2–8ºC and kept in the outer carton to protect from light.

Are there any alternatives?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Your doctor or rheumatology nurse will discuss these other options with you.

Will I need any special checks while on etanercept?

You will have a chest x-ray, blood tests and a physical examination to check whether you have ever been exposed to tuberculosis (TB) or hepatitis. Some patients may need a course of treatment for latent (asymptomatic) TB before starting etanercept. You may also have further blood tests while you are on etanercept to monitor its effects.

Etanercept may increase the risk of a hepatitis infection being reactivated in people who carry the virus. If your doctor decides that you may be at risk from a previous hepatitis infection, they may test your blood for the presence of hepatitis.

Can I take other medicines alongside etanercept?

Etanercept may be prescribed along with other drugs, including methotrexate. You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you’re on etanercept.

You should also be aware of the following points:

  • Etanercept is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as etanercept, unless your doctor advises otherwise. If etanercept works for you, you may be able to reduce your NSAIDS or painkillers after a time.
  • Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

Can I continue with etanercept if I am going to have an operation?

If you are going to have an operation please inform your doctor, as you may be advised to stop etanercept temporarily before and after surgery. It is important to remember to re-start the drug after surgery otherwise you might suffer a flare-up of your arthritis.

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