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Enbrel (also referred to by its generic name, etanercept) is a biologic medication that is used to treat severe psoriasis and/or psoriatic arthritis.
How does Enbrel work?
Enbrel blocks tumour necrosis factor-alpha (TNF alpha) a chemical ‘messenger’ in the immune system that signals other cells to cause inflammation. There is too much TNF alpha in the skin of people with psoriasis and the joints of people with psoriatic arthritis, which causes inflammation and can lead to tissue and joint damage. TNF alpha can also lead to increased activity of the immune system by switching on certain white blood cells in the body, called T Cells. Once T cells become overactive they can trigger inflammation and other immune responses, encouraging the development of psoriasis.
Enbrel helps lower the amount of TNF alpha to more normal levels, and switches off the inflammatory cycle of psoriasis and psoriatic arthritis. This leads to improvement in symptoms for many people who take it.
Who is Enbrel for?
Enbrel can be prescribed to treat severe plaque psoriasis in adults and children over the age of eight. Usually it will only be offered to people who have not responded to, or cannot take non-biologic systemic treatments including ciclosporin, methotrexate or PUVA light therapy.
Enbrel can also be prescribed to treat active and ‘progressive’ (worsening) psoriatic arthritis in adults, if the response to other disease modifying anti-rheumatic drug treatments has been inadequate. This means that if you have taken treatments such as methotrexate, sulfasalazine or leflunomide for your psoriatic arthritis without a good response, you could be offered Enbrel.
How is Enbrel used?
Individuals take Enbrel at home by giving themselves an injection under the skin via a pre-filled ‘pen’ device. Most people will be trained by a nurse to give the injection to themselves. Either one or two injections are taken per week, depending on your doctor’s recommendations. Enbrel can be prescribed by itself or is sometimes used in combination with methotrexate.
People taking Enbrel will have regular blood tests every three to six months- usually carried out by Dermatology Nurses, or by their own GP- to monitor for infections or other possible effects of the treatment. People taking Enbrel should have an annual flu jab, but should check with a doctor or nurse before having any other vaccinations or taking other medication.
Who should not take Enbrel?
- People with active infections should not start Enbrel. You will be tested to check for infections before starting treatment.
- In most cases, pregnant women should not be treated with Enbrel and women should not breastfeed during treatment with Enbrel. Women should not fall pregnant or breast feed for three weeks after treatment has stopped.
- Enbrel should be used with caution in those with already impaired immune systems, a history of heart failure or a history of cancer. Your Dermatologist or Rheumatologist should discuss this with you, if relevant.
What are the side effects of Enbrel?
As with all medications, some side effects are possible when taking Enbrel. It is important to remember that not every person taking a medication will get all, or even any, of the possible side effects listed. Many side effects of Enbrel are mild and do not cause most patients to stop taking it.
The most common side effects for people taking Enbrel include dizziness, sore throat, cough, stomach pain, injection site reactions (irritation, redness or swelling around the area that Enbrel as injected), upper respiratory infections (such as sinusitis), headache and tiredness. Because Enbrel works by suppressing part of the activity in the immune system, it can make people taking it more prone to infections than they usually would be. If a serious infection occurs a doctor will most likely stop Enbrel.
Although side effects are possible with this, and any, treatment, it is important to remember that people taking Enbrel have regular blood tests to check for health issues. If you are worried about the side effects of Enbrel, you should discuss these with your doctor.
How long will Enbrel take to work?
It can take a number of weeks before a person’s psoriasis or psoriatic arthritis improves on Enbrel. If considerable improvement is not seen in three months, treatment with Enbrel will be stopped. If this happens, a Dermatologist or Rheumatologist should discuss the next available options with you - there are a number of other biologic or systemic treatments that can be tried if Enbrel does not work.
How safe and effective is Enbrel?
Enbrel has been used to treat psoriasis in the UK since 2006. ‘Real-world’ safety and effectiveness data is being compiled by the British Association of Dermatologists Biologics Interventions Register (BADBIR). It is recommended that all people taking biologic treatments for their psoriasis should be asked for their data to be included in this register.
The information on this page is also available in our Enbrel (Etanercept) information sheet.