What Is Enbrel (Etanercept)?

Enbrel® (etanercept) is a systemic treatment option for plaque psoriasis in patients 4 years old and above. It is also approved for treating psoriatic arthritis and rheumatoid arthritis. The medicine has been on the market under the brand name Enbrel since 2004, although it may be available generically in coming years¹.

The active ingredient in Enbrel is etanercept, which is a type of biologic therapy that is created in the laboratory. Enbrel is generally prescribed for people who need a stronger systemic medicine or phototherapy to treat their psoriasis symptom than topical treatments, or for people who have tried other types of systemic or biologic treatments but they have not worked well enough².

As a systemic biologic therapy, Enbrel affects the way the patient’s immune system works to treat psoriasis. It is administered through an injection as a maintenance treatment to be taken over a longer period of time.

How does Enbrel (etanercept) work to treat plaque psoriasis?

Plaque psoriasis is a chronic autoimmune condition, in which excess inflammation in the body causes new skin cells to be produced more quickly than older skin cells can be shed. This causes plaques to develop on the skin. People with psoriasis have an immune system that is overactive and produces too many proteins called cytokines. These cytokines play a key role in the immune system processes that cause excess inflammation.

The active ingredient in Enbrel, etanercept, is a type of biologic therapy called a tumor necrosis factor-alpha (TNF-alpha) blocker². TNF-alpha is a type of cytokine that is over-produced in the bodies of people with psoriasis, contributing to the excess inflammation that causes symptoms. Etanercept works by targeting and blocking the function of TNF-alpha cytokines to disrupt the cycle of inflammation and reduce symptoms³.

Clinical studies have examined the effect of Enbrel in treating psoriasis. The results show that after three months of treatment with Enbrel, almost half of adults had a reduction in their symptoms of at least 75%, and three-quarters of patients had 50% reduction⁴. Many of the patients had symptom improvement that was maintained after 6 months of treatment. Some patients (around 18%) begin to see improvement after 2 weeks of treatment with Enbrel.

How is Enbrel (etanercept) administered?

Patients take Enbrel by injecting it using a pre-filled syringe or auto-injector pen, usually into the thigh, upper arm, or abdomen. It also comes as Enbrel Mini, a single-dose prefilled cartridge for use with the AutoTouch reusable autoinjector.⁵ Most patients are able to inject themselves with the medicine after being trained by a healthcare provider about how to do it safely. Injecting into a different area for each dose can help to reduce side effects on the skin, such as soreness².

The medicine needs to be kept in the refrigerator when not in use. It can only be kept at room temperature for a maximum of 14 days³.

Who can take Enbrel (etanercept)?

Enbrel is approved for treating patients 4 years old and above with moderate-to-severe plaque psoriasis who need treatment with phototherapy or systemic treatments.

Before prescribing Enbrel, healthcare providers need to know if the patient⁴:

• has or has had heart failure
• has a surgery planned
• has a vaccine planned
• has or has had a nervous system condition, like multiple sclerosis or Guillain-Barre syndrome
• has been in contact with someone with chicken pox
• is allergic to latex
• consideration of other medications and infections

What are the side effects and risks of taking Enbrel (etanercept)?

The most common side effect of treatment with is reactions on the skin where the medicine is injected (redness, pain, itching, or swelling). These reactions tend to be worse when starting treatment, and then get better. Other common side effects are headaches and upper respiratory infections.

TNF-alpha blocker medicines such as Enbrel are extremely strong and can cause some serious side effects. The way the drug affects the immune system can make it harder to fight various types of infections². If you currently have any type of infection, it is unlikely your healthcare provider will prescribe Enbrel until the infection is completely cleared. Patients are tested for infections (such as tuberculosis) before starting Enbrel and are monitored for symptoms of infection during and after treatment. People who have had a hepatitis B infection in the past may develop the infection again during treatment with Enbrel. Patients will be tested for hepatitis B before starting treatment⁴.

In a small number of patients, Enbrel can cause very serious problems such as⁴:

• nervous system problems (such as multiple sclerosis, seizures, or eye problems)
• blood problems that affect the body’s ability to fight infections and/or stop bleeding
• heart failure
• worsened psoriasis symptoms
• allergic reactions
• autoimmune reactions, such as lupus-like syndrome or autoimmune hepatitis

To monitor for these conditions, patients treated with Enbrel will usually have regular blood tests and symptom screening by healthcare providers.

Enbrel has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because:

• It can increase your risk of serious infections
• Cancer has been reported in children and adolescents treated with Enbrel

These are not all the possible side effects of Enbrel. Talk to your doctor about what to expect when taking Enbrel. You also should call your doctor if you have any changes that concern you when taking Enbrel.

Can Enbrel (etanercept) be used with other treatments or drugs?

Your healthcare provider will advise you about whether you can take Enbrel with other types of treatments with psoriasis. Many patients are able to take Enbrel in combination with topical treatments, the systemic drug methotrexate, and/or phototherapy.