Etanercept

Etanercept (brand 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 can reduce this inflammation.

Why is etanercept prescribed?

Etanercept is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and for children with juvenile idiopathic arthritis (also known as JIA or JCA).

Etanercept will only be prescribed if your arthritis is active. If you have rheumatoid arthritis it will only be used if you have already tried methotrexate and another disease-modifying anti-inflammatory drug (DMARD) such as sulfasalazine or gold injections, or cannot use these. Slightly different conditions may apply in the case of the other diseases.

Etanercept will not be prescribed if:

• your rheumatoid arthritis is not active
• you have not tried standard treatments first
• you are pregnant or breastfeeding
• 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 infections
• you have or have had multiple sclerosis (MS)
• you have had cancer
• you have or have had a serious heart condition
• you have lung fibrosis.

When and how do I take etanercept?

Etanercept is only available on prescription from a consultant rheumatologist. Etanercept is given by subcutaneous injection (an injection under the skin) once or twice a week. You, your partner, or another member of your family can learn to give the injections. If this is not possible, the injections can be given by your rheumatology nurse specialist or district nurse.

If you are being prescribed etanercept it is recommended that you carry a biological therapy alert card, which you can obtain 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.

How long does etanercept take to work?

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

What are the possible risks or side-effects?

Etanercept may cause a blocked or runny nose, headache, dizziness, rash, stomach pain or indigestion. You may also get inflammation around the injection site.

Taking etanercept can sometimes affect the blood count (the number of blood cells present in your blood) and 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 such as etanercept which affect the immune system (the body’s own defence system). Therefore you may need antiviral treatment, which your doctor will be able to prescribe.

It is possible that there may be a slightly increased risk of certain types of cancer in patients using anti-TNF drugs. Such a link has not been proven but is the subject of current research. Please discuss this with your doctor if you are concerned. Anti-TNF drugs have been associated with certain types of skin cancer – these can be readily treated when diagnosed early.

As yet, the long-term side-effects of etanercept are not fully understood because it is a relatively new drug.

How can I reduce the risk of infection?

Because of its effects on the immune system, etanercept may make you more susceptible to food-borne infections such as salmonella and listeria, which can result in food poisoning and other serious illnesses. You can minimise this risk by avoiding foods such as:

• raw eggs or products made from raw eggs (such as mayonnaise, although many commercially available products are safe)
• unpasteurised milk
• mould-ripened soft cheeses (e.g. Brie and Camembert) and blue cheeses (whether pasteurised or unpasteurised), feta and goat’s cheese
• undercooked meat and poultry
• all types of pâté.

You should also wash all raw fruit and vegetables and ensure that chilled ready meals are thoroughly cooked before eating. For further advice see the Food Standards Agency website: www.eatwell.gov.uk/keepingfoodsafe.

What other treatments could be used instead of etanercept?

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

Will I need any special checks while on etanercept?

You will have a chest x-ray and blood tests before starting treatment. You may also have further blood tests while you are on etanercept to monitor its effects.

Can I take other medicines along with etanercept?

Etancercept 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 are on etanercept.

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.

Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

What about immunisations?

If you are on etanercept it is recommended that you should not be immunised with ‘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 immunisation with you.

Pneumovax (which gives protection against the commonest 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. However, if you are also taking methotrexate, you should only drink alcohol in small amounts because methotrexate and alcohol can interact and damage your liver.

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 the etanercept temporarily before and after surgery.

Does etanercept affect fertility or pregnancy?

No-one knows the risk of etanercept to an unborn baby. Women of childbearing age therefore must use contraception while on etanercept. You should not take etanercept if you are thinking of becoming pregnant in the near future or if you are not using contraception.

What about breastfeeding?

You should not breastfeed if you are on etanercept. The drug may pass into the breast milk and could be harmful to your baby.

Where can I obtain further information?

If you would like any further information about etanercept, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.

Remember to keep all medicines out of reach of children.

PLEASE NOTE: We have made every effort to ensure that this content is correct at time of publication, but remember that information about drugs may change. This page is for general education only and does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects that may be relevant in your particular case.

Our drug information is revised annually and published at the start of the year.