Etanercept

Etanercept is a biologic medication that is used to treat severe psoriasis and/or psoriatic arthritis. It is known by the brand names Enbrel and Benepali.

Enbrel was the first version of Etanercept to be made and is the ‘originator’ medicine. The patent for Enbrel expired in 2012. The Etanercept biosimilar, Benepali, came to the market in 2016. Benepali works in the same way as Enbrel, and has the same treatment effects, but there are slight differences between them i.e. Benepali is ‘similar’ to the original biologic medicine. You should be prescribed Etanercept by the brand name (Enbrel or Benepali) so that it is clear which is being used. All versions of Etanercept are taken by injection.

How does Etanercept work?

Etanercept 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.

Etanercept 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 Etanercept for?

Etanercept 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.

Etanercept 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 Etanercept.

How is Etanercept used?

Individuals take Etanercept at home by giving themselves an injection under the skin via a pre-filled ‘pen’ device or pre-filled syringe. Most people will be trained by a nurse to give the injection to themselves. Your doctor will discuss with you how frequently you will need to administer your injection, this could be once or twice per week. Etanercept can be prescribed by itself or is sometimes used in combination with methotrexate.

People taking Etanercept will have regular blood tests every three to six months - usually carried out by Dermatology or Rheumatology Nurses, or by their own GP - to monitor for infections or other possible effects of the treatment. People taking Etanercept 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 Etanercept?

  • People with active infections should not start Etanercept. You will be tested to check for infections before starting treatment.
  • In most cases, Etanercept should not be used if you are planning to have a baby, or are pregnant. If you become pregnant whilst taking Etanercept, speak to your Dermatologist or Rheumatologist as soon as possible about the benefits and possible risks. If Etanercept treatment is necessary during pregnancy, your baby may be at a higher risk of infection once they’ve been born. Speak to your doctor regarding your baby’s routine immunisations, as it may be necessary to delay the live vaccines to avoid any risks of infection. Etanercept should not be used if you are breastfeeding.
  • Etanercept should be used with caution in people with multiple sclerosis or other similar types of demyelinating (destruction of nerve tissue) neurological diseases. Your Dermatologist or Rheumatologist should discuss this with you, if relevant.

What are the side effects of Etanercept?

As with all medications, some side effects are possible when taking Etanercept. 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 Etanercept are mild and do not cause most patients to stop taking it.

The most common side effects for people taking Etanercept include infections (such as colds, sinusitis, bronchitis, urinary tract infections and skin infections); injection site reactions (including bleeding, bruising, redness, itching, pain, and swelling); and headache. Other common side effects include allergic reactions; fever; rash; itching.

Although side effects are possible with this, and any, treatment, it is important to remember that people taking Etanercept have regular blood tests to check for health issues. If you are worried about the side effects of Etanercept, you should discuss these with your doctor.

How long will Etanercept take to work?

It can take a number of weeks before a person’s psoriasis or psoriatic arthritis improves on Etanercept. If considerable improvement is not seen in 12 weeks, treatment with Etanercept 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 Etanercept does not work.

How safe and effective is Etanercept?

Etanercept, in the form of 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 and Immunomodulators Register (BADBIR) and the British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA). The National Institute for Health and Care Excellence (NICE) recommends that all patients receiving biologic therapy, who provide their consent, are entered onto these observational study registers. 

Resources

The information on this page is also available in our Etanercept information sheet.

August 2021 (Review Date: August 2022)

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