Enbrel (etanercept) is a systemic treatment option for adults with moderate to severe plaque psoriasis. 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 using human proteins. 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 (usually once or twice per week) 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 patients 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. 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.
Generally, the starting dose of Enbrel is one injection twice per week for the first 12 weeks. After that, the usual dose is one injection per week. The medicine needs to be kept in the refrigerator when not in use; it can be kept at room temperature, but only for a maximum of 14 days3.
Who can take Enbrel (etanercept)?
Enbrel is approved for treating adults with moderate-to-severe plaque psoriasis who need treatment with phototherapy or systemic treatments. It is not suitable for women who are pregnant or breastfeeding3.
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
What are the side effects and risks of taking Enbrel (etanercept)?
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
- Patients with more severe psoriasis may have a slightly higher chance of developing a type of cancer called lymphoma
To monitor for these conditions, patients treated with Enbrel will usually have regular blood tests and symptom screening by healthcare providers.
The most common side effects of treatment with Enbrel are not as serious, such as 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.
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.