Etanercept

Etanercept is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), and ankylosing spondylitis (AS).

For RA and PsA, etanercept may be used as monotherapy or in combination with DMARD therapy, such as methotrexate (MTX).

Etanercept may be used as monotherapy for treatment of AS that has not responded to DMARD therapy.

Etanercept is delivered by subcutaneous (s.c.) injection (meaning in the fatty layer of tissue just under the skin).

Etanercept is usually given either once or twice a week. The dose given is 50 mg per week or 25 mg twice a week. In some circumstances, etanercept may be given in 50 mg doses twice a week.

The medication comes in multiple use vials, single-use pre-filled syringes and single-use pre-filled SureClick autoinjectors for administration.

In some people with arthritis, a signalling protein called a tumour necrosis factor (TNF) is present in the blood and joint in excessive amounts where it increases inflammation. Etanercept works by suppressing the body’s immune system, specifically it binds to tumour necrosis factor and prevents it from causing inflammation. By doing this, etanercept can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all biologics, you may not feel the effects of the etanercept right away. Some people begin to feel the effects of the medication fairly quickly; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for etanercept to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Etanercept can make it harder for you to fight infections. People with active infections should not take etanercept. If you have a fever, think you have an infection, or have been prescribed an antibiotic contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of etanercept with their healthcare provider. 

Also contact your healthcare provider if you are having surgery as you may need to stop etanercept until you are healed and there is no sign of infection.

Etanercept has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made with your healthcare provider whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.

Anyone who has had a previous allergic reaction to etanercept should avoid the medication.

Anyone with a history of cancer or nervous system problems (like multiple sclerosis) should discuss the use of etanercept with their healthcare provider.

Etanercept may make a condition called congestive heart failure worse. Tell your doctor if you have congestive heart failure.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because etanercept can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start etanercept.

Make sure that your vaccinations are up to date before starting etanercept. Your healthcare provider will likely recommend a number of vaccines (e.g., influenzae, pneumonia, RSV, shingles) to get beforehand. Because etanercept can reduce your ability to react to vaccines, you should wait at least two to three weeks after your vaccine before starting etanercept. If you are already on etanercept and need a vaccination, try to space it as long as you can after your last dose.  Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking etanercept, you should speak with your healthcare provider.

Like all medications, taking etanercept carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability is much greater than the risks of side effects from etanercept. When monitored properly the vast majority of side effects are rare and most improve over time and are reversible.

Etanercept can increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

Etanercept can rarely cause a reaction (redness, pain, and itching) at the injection site. Talk to your healthcare provider if these symptoms become severe.

Rarely some people experience headaches with etanercept. If this becomes severe, please speak with your healthcare provider.

Some people have developed lupus-like symptoms that disappeared after the medication was stopped. If you have chest pains that do not go away, shortness of breath or a rash on your cheeks or arms that gets worse in the sun, call your doctor right away.

There have been rare cases of disorders that affect the nervous system of people taking etanercept or other TNF-blockers. Signs that you could be experiencing a problem affecting your nervous system include numbness or tingling, problems with your vision, weakness in your legs, and dizziness.

Etanercept very rarely can cause a drop in blood counts.

Take etanercept as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

To avoid injection site reactions injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

Blood tests are not routinely required while you are taking etanercept. Your healthcare provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Etanercept must be refrigerated at 2 to 8 degrees Celsius and protected from light. Keep the product in the original package.

Etanercept must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.

Once etanercept is transferred to room temperature, it cannot be returned to the fridge for storage and is stable for use within 28 to 60 days depending on the version of etanercept. If not used within this time period, it must be disposed by returning to the pharmacy.

Each version of etanercept has its own patient support program. These can be found in the list below.

• Brenzys
  PSP: Harmony (1-866-556-5663)
• Enbrel
  PSP: Enliven (1-877-936-2735)
• Erelzi
  PSP: XPOSE (1-844-279-7673)
• Rymti
  PSP: to be announced