Etanercept
โ ๏ธ Active tuberculosis must be treated with standard therapy for at least 2 months before starting etanercept.
Always check the BNF or local formulary before prescribing.
๐ About
- AntiโTNF-ฮฑ agent: binds to soluble TNF receptors, blocking inflammatory signalling.
- Specialist use only (rheumatology, dermatology).
- Annual cost โ ยฃ9295 (assuming 52 doses/year).
๐งฌ Aetiology & Mechanism
- Comprises two soluble TNF-ฮฑ receptor molecules fused with human IgG1 Fc fragment.
- Does not bind TNF-ฮฒ receptors or membrane-bound TNF.
- โ Pro-inflammatory cytokine activity โ improved disease control in autoimmune conditions.
โ ๏ธ Concerns
- โ Risk of serious infections (esp. TB, fungal, opportunistic).
- Screen for latent TB, hepatitis B & C, HIV before initiation.
- Immunosuppression may mask signs of infection.
๐ฏ Indications
- Severe rheumatoid arthritis (RA).
- Moderate-to-severe plaque psoriasis.
- Severe ankylosing spondylitis.
- Active, progressive psoriatic arthritis.
๐ Dosing โ Etanercept (check BNF/local datasheet)
| Regimen |
Details |
| ๐
Standard dosing |
โข 25 mg SC twice weekly
โข 50 mg SC once weekly
|
| โ๏ธ Adjustment |
โข Modify based on specialist advice and patient response
โข Not interchangeable with other TNF inhibitors without review
|
๐ซ Contraindications
- Active infection (incl. sepsis, chronic or localised infections).
- Do not initiate in untreated latent/active TB.
โ ๏ธ Side Effects
- Injection site reactions (pain, erythema).
- Serious infections (TB, sepsis, pneumonia).
- Blood disorders (pancytopenia, aplastic anaemia).
- CNS demyelination (rare).
- GI upset, headache, rash.
๐ References
๐ก Pearls:
- Always screen for latent TB & hepatitis B before starting.
- Combine with methotrexate in RA for maximal efficacy.
- Monitor for infection, cytopenias, demyelination during therapy.
