Etanercept for rheumatoid arthritis

Examples

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Brand Name	Chemical Name
Enbrel	etanercept

Etanercept is given as a shot under the skin (subcutaneous injection).

How It Works

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Etanercept reduces the effects of tumor necrosis factor (TNF). TNF is a protein that attaches to the joint surface and causes inflammation and joint damage. Etanercept blocks the action of TNF and reduces symptoms and slows the progression of rheumatoid arthritis.

Etanercept is a disease-modifying antirheumatic drug (DMARD), which means it slows the progression of the disease. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).

Why It Is Used

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Etanercept is used to treat severe rheumatoid arthritis when other medications have not been effective. It also may be used in combination with methotrexate.

How Well It Works

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Etanercept works quickly with minimal side effects. It appears to affect disease activity within weeks.¹ Several studies report significantly reduced disease activity within 6 months of beginning etanercept treatment.¹ When used alone or in combination with methotrexate, it decreases pain and swelling better than methotrexate alone.² Combining etanercept with methotrexate has produced good results, greatly slowing damage to joints while increasing functional ability.³

Etanercept is effective in relieving joint pain and swelling in rheumatoid arthritis that has not improved with methotrexate or other DMARDs.⁴

Side Effects

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Side effects are not common but include:

• Risk of infection.
• Redness and irritation where the shot was given.
• Coldlike symptoms (mild sore throat, runny nose, cough).
• Lowering of white blood cell counts (rare).
• Worsening of underlying multiple sclerosis.

Risk of infection

Etanercept decreases the activity of your body's immune system, which increases the risk of a serious bacterial infection. Some people who take etanercept develop an infection that requires oral antibiotics; a smaller number of people will develop an infection that requires intravenous antibiotics and hospitalization. Contact your health professional if you develop any of the following symptoms:

• Fever or chills
• Increased frequency of or burning during urination
• A cough with yellow sputum or shortness of breath
• A skin infection
• Severe abdominal pain or diarrhea
• A severe sore throat
• Sinus pain with yellow mucus
• A painful, burning rash in a band across one side of your body (shingles)
• Painful, widespread mouth sores

Etanercept can reactivate tuberculosis (TB) in people who have been previously infected with TB. Before starting etanercept treatment, you should be screened with a tuberculin skin test and a recent chest X-ray. If the skin test is positive or the chest X-ray suggests prior exposure to TB, you will need treatment to prevent active TB.⁵

Etanercept suppresses the immune system, making it difficult for the body to fight infection. Therefore, etanercept cannot be given to a person with an active viral or bacterial infection, nor within 3 months of a live-virus vaccine.

People with rheumatoid arthritis have a slightly higher risk of getting cancer of the lymph glands, called lymphoma, than people without rheumatoid arthritis. But lymphoma is rare even for people with rheumatoid arthritis. Experts do not know why this risk is higher for people with rheumatoid arthritis—it may be because the disease is severe or because of the medicines used to treat it. Studies are currently under way to explain this. Talk with your doctor about the benefits and risks of DMARD therapy.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Etanercept is expensive; it may cost significantly more than other DMARDs.²

Etanercept should not be used by pregnant women or women of childbearing age who are not using reliable birth control. If you are going to take etanercept, you should be on some form of reliable birth control. If you plan to become pregnant, check with your health professional before stopping birth control and trying to become pregnant.

Etanercept is a relatively new medication. Its long-term safety and effectiveness are not fully known.¹

Etanercept can be self-administered once you receive training and instructions from your health professional.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Emery P, Suarez-Almazor M (2002). Rheumatoid arthritis. Clinical Evidence (10): 1454–1476.

2. Blumenauer B, et al. (2005). Etanercept for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.

3. Klareskog L, et al. (2004). Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: Double-blind randomised controlled trial. Lancet, 363(9410): 675–681.

4. Kremer JM (2001). Rational use of new and existing disease-modifying agents in rheumatoid arthritis. Annals of Internal Medicine, 134(8): 695–706.

5. Drugs for rheumatoid arthritis (2005). Treatment Guidelines From the Medical Letter, 3(40): 83-90.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	August 23, 2006