Etanercept (Enbrel)
Enbrel (etanercept) is a biologic medicine that helps the pain and swelling of arthritis.
Enbrel is a very common treatment for Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Psoriasis, and Juvenile Arthritis. It can also be used to treat certain other diseases.
Enbrel works by blocking Tumor Necrosis Factor (TNF), a type of signalling protein (cytokine) that is involved in systemic inflammation. Enbrel belongs to a class of similar medications called “Anti-TNF” agents.
Taking Enbrel
Enbrel is available as a subcutaneous (under the skin) injection that can be taken at home.
Enbrel is usually taken once a week. It is sometimes prescribed for twice a week. The standard dose is 25-50 mg.
Subcutaneous injections (under the skin injections) are easy to do compared to other types of injections. A small needle pokes just under the skin to deliver medicine into the “fatty tissue” below.
Learn how take Enbrel at home:
Learn how to inject subcutaneous injectionsLearn how to inject autoinjectorsThe Enbrel autoinjector is sold under the brand name “Sureclick”.
The manufacturer of Enbrel offers a support program to Canadian patients that are prescribed the medication:
Patient support program enrolment formsImportant Tests and Risks
Enbrel can make it a bit harder for people to fight off infections.
People taking this medicine should call their doctor if they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
Patients should coordinate with their doctor to stop treatment before any surgery. It can be re-started once things have healed and there’s no sign of infection. Most patients stop the medication a week or two before surgery. It can be restarted 10-14 days after the surgery as long as there is no sign of infection.
Patients should discuss all vaccinations with their doctor because some (live vaccines) are not advisable to get while taking Enbrel.
It is important to have a TB (tuberculosis) skin test and a chest x-ray before starting Enbrel.
Science
In some people with arthritis, a signalling protein (cytokine) called Tumor Necrosis Factor (TNF) is present in the blood and joints in excessive amounts where it increases inflammation (pain and swelling).
Enbrel (etanercept) is another type of protein called a fusion protein that was developed by scientists to block Tumor Necrosis Factor. It is built out of other proteins that are found in the human body including part of an antibody that can normally found in the blood, and with a receptor called Tumor Necrosis Factor receptor 2 that binds to Tumor Necrosis Factor.
When Enbrel binds to Tumor Necrosis Factor, it blocks it from working. This makes it part of a family of arthritis medicines called Tumor Necrosis Factor Blockers. In blocking Tumor Necrosis Factor, Enbrel suppresses the body’s immune system.
Though this suppression can make it slightly harder for patients to fight off infections, it also helps to stabilize an overactive immune system.
In patients with arthritis, this medicine can:
- Reduce the pain and swelling (inflammation) in arthritic joints
- Improve day to day function
- Prevent long-term damage caused by joint inflammation
Safety
Patients should talk to their doctor if they are concerned about any side effects.
All fevers and infections should be reported to a doctor.
MORE COMMON side-effects include:
- Mild skin reaction at the injection site (itchiness, redness, and mild swelling)
- Headaches
- Upper respiratory tract infections (such as sinusitis)
RARE side-effects include:
- Blood Counts – Enbrel can cause a drop in the numbers of white blood cells (which are needed to fight infection) or red blood cells (which carry oxygen). This is very rare and it is unusual for this to be a serious problem. Patients should get occasional blood tests so their doctor can monitor their liver and blood counts.
- Infection – There is an increased risk of serious infection. Any infections or fevers should be taken seriously and reviewed by a doctor
- Nervous System – There have been rare reports of some patients developing disorders that affect the nervous system (multiple sclerosis, seizures, or inflammation of the nerves of the eye) while taking Enbrel. Fortunately, these reports are exceedingly rare.
- Heart – Patients should inform their doctor if they have congestive heart failure as Enbrel may make it worse.
- Malignancy – When used for long periods of time, Enbrel may be associated with a small increased risk of cancer, however, the data is not entirely clear.
How to minimize the side-effects of Enbrel:
- Enbrel should be taken as prescribed by a doctor
Enbrel should not be taken with other medications that also block TNF.
Patients who should NOT be taking Enbrel (etanercept) include:
- Patients who have had a previous serious allergic reaction to Enbrel (etanercept)
- Patients taking other biologic medications or JAK inhibitors
- Possibly patients who have cancer or have had a past history of certain cancers
- Patients who have severe or uncontrolled congestive heart failure
- Patients who have multiple sclerosis
- Patients with active infections (such as tuberculosis)
People taking Enbrel should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons for people taking Enbrel to call a doctor include:
- Fever, infection, or suspected infection
- If another doctor has prescribed antibiotics to fight an infection
- Upcoming surgery
- Planning to get a vaccination – not all vaccinations are safe with Enbrel
- Development of a rash
Anyone who becomes pregnant while taking Enbrel should notify their doctor.
Pregnancy and medicationsVideo
Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Enbrel in this short video:
Resources
DIN
- 02274728 (SC)
- 02242903 (SC)