ETANERCEPT

By Gary M. White, MD

Note: This is a summary only. Please consult the latest information when prescribing.


Etanercept and Psoriasis

If not significantly improved at week 12, can add in nbUVB or MTX.

Black Box Warnings

Serious Infections, including tuberculosis.

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including Enbrel.

Side Effects

Indications

Contraindications

Don't use in pt with CHF -don't use in pt with hx of CHF unless other tx have failed. Don't use in pt's with history or family history of multiple sclerosis, optic neuritis, or transverse myelitis.

Dose

For psoriasis 50 mg Sub Q 2/week separated by 3 days x 3 months, then 50 mg once per week. After induction (12 weeks) taper to lowest effective dose (many do okay on 25 mg/wk).

Monitoring/Labs

Yearly PPD
No labs required.
Consider asking about blurred vision, paresthesias, confusion, or unilateral neurologic sx on f/u to r/o MS (but so far only case reports...16 total of hundreds of thousands of pts on Enbrel, mostly for RA).

Pediatrics

Enbrel is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in patients ages 2 and older. It is not yet FDA-approved for children with psoriasis.

No live vaccines during tx (if needed, d/c Enbrel for 2 weeks, then give vaccine, then restart after 2weeks). Ok for killed vaccines.

Side Effects

Multiple SCCs have developed in the sun-exposed areas of patients on etanercept for 2.5-4 months [JAAD 2001;45;953].

Pregnancy Category

A study by the Organization of Teratology Information Specialists found that etanercept exposure during pregnancy more than doubled the risk of major congenital malformations. There was however, no pattern in the defects and no biological plausibility because the drug does not seem to cross the placenta. More studies are needed.

OBSERVE-5

Observational post marketing safety surveillance registry of etanercept, 5 year results [JAAD 2015;72;115]. Rates of malignancies,lymphomas, non melanoma skin cancer and hospitalization-associated infections were not higher than controls. The precent of patients clear /almost clear was 51% at month 6 and remained stable over 5 years.


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