Etanercept
A DRUG Information Sheet
What is etanercept?
Etanercept (brand name Enbrel) is a type of drug known as anti-TNF. In people with rheumatoid arthritis and some other inflammatory diseases a protein called TNF is present in the blood and joints in excessive amounts, where it increases inflammation. Anti-TNF drugs block the action of TNF and so can reduce inflammation. In this way they can help people with active rheumatoid arthritis and other types of arthritis.
Why am I being prescribed etanercept?
Etanercept is available for people with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and for children with juvenile idiopathic arthritis (also known as JIA or JCA). It will only be prescribed if your arthritis is active. Also, if you have rheumatoid arthritis it will only be used if you have already tried methotrexate and another standard 'second-line' treatment (e.g. sulfasalazine, gold injections). It may also be prescribed if you cannot tolerate other treatments. Slightly different conditions may apply in the case of the other diseases. Etanercept is available only on prescription from a consultant rheumatologist.
Etanercept will not be prescribed if:
- your rheumatoid arthritis is not active
- you have not tried standard treatments first
- you are pregnant or breastfeeding
- you have an infection.
Your doctor may decide not to prescribe etanercept if:
- you have had tuberculosis (TB) in the past
- you have had other repeated infections
- you have or have had multiple sclerosis (MS)
- you have had cancer
- you have or have had a serious heart condition.
When and how do I take etanercept?
Etanercept has to be given by subcutaneous injection (an injection under the skin, like insulin injections for diabetes) once or twice a week. You, your partner, or another member of your family can learn to give the injections. If this is not possible, the injections can be given by your rheumatology nurse specialist or district nurse.
If you are being prescribed etanercept it is recommended that you carry a biological therapy alert card, which you can obtain from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on etanercept.
How long will etanercept take to work?
If you respond to etanercept you will probably feel better in 2–12 weeks.
What are the possible risks or side-effects?
Etanercept may cause a blocked or runny nose, headache, dizziness, rash, abdominal pain or indigestion.
You may get inflammation around the injection site.
Taking etanercept can sometimes affect the blood count (the number of blood cells present in your blood) and can make you more likely to develop infections. If you develop a sore throat or other symptoms of infection, if you have a fever, if you develop unexplained bruising, bleeding or paleness, or if you develop any new symptoms after starting etanercept, you should see your doctor or rheumatology nurse immediately. If any of these symptoms are severe, you should stop etanercept and see your doctor immediately.
If you have not had chickenpox but come into contact with someone who has chickenpox or shingles, or if you develop chickenpox or shingles, you should stop etanercept and see your doctor immediately as you may need special treatment. This is because chickenpox and shingles can be severe in people on treatment such as etanercept which has effects on the immune system (the body's own defence system). Therefore you may require antiviral treatment.
Rarely, people may be allergic to etanercept. If this is the case with you, the drug will have to be stopped.
As yet, the long-term side-effects of etanercept are not known because it is a relatively new drug.
What other treatments could be used instead of etanercept?
A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions (see arc leaflet 'Drugs and Arthritis'). Your rheumatologist will discuss these other options with you.
How can I reduce the risk of infection?
As a result of its action on the immune system, etanercept may make you more susceptible to food-borne infections such as salmonella and listeria, which may result in food poisoning and other serious illnesses. You can minimise this risk by avoiding foods such as:
- raw eggs or products made from raw eggs (such as mayonnaise, although many commercially available products are safe)
- unpasteurised milk
- mould-ripened soft cheeses (e.g. Brie and Camembert) and blue cheeses (whether pasteurised or unpasteurised), feta and goat's cheese
- undercooked meat and poultry
- all types of pâté.
You should also wash all raw fruit and vegetables and ensure that chilled ready meals are thoroughly cooked before eating. For further advice see the Food Standards Agency website: www.eatwell.gov.uk/keepingfoodsafe.
Do I need any special checks while on etanercept?
You will have a chest x-ray and blood tests before starting treatment. You may also have further blood tests while you are on etanercept to monitor its effects.
May I take other medicines along with etanercept?
Etancercept may be prescribed along with other drugs, including methotrexate (see separate arc leaflet 'Methotrexate'). If you are on methotrexate, special care is needed with non-steroidal anti-inflammatory drugs (NSAIDs). You may only take anti-inflammatory drugs if they are prescribed to you by your doctor.
You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking etanercept.
Etanercept is not a painkiller. So if you are on painkillers you may continue to take these as well as etanercept, unless your doctor advises otherwise.
Do not take over-the-counter preparations without discussing this first with your doctor, rheumatology nurse or pharmacist.
Can I have immunisations while on etanercept?
It is recommended that you should not be immunised with 'live' vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella immunisation in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the immunisation with you.
Pneumovax and yearly flu vaccines are safe and recommended.
May I drink alcohol while taking etanercept?
You may drink alcohol while taking etanercept. However, if you are also taking methotrexate, you should only drink alcohol in small amounts because methotrexate and alcohol can interact and damage your liver.
May I continue with etanercept if I am to have an operation?
If you are to undergo surgery, please inform your doctor, as you may be advised to stop the etanercept temporarily before and after surgery.
Does etanercept affect pregnancy?
No-one knows the risk of etanercept to an unborn baby. Women of child-bearing age must use contraception while on etanercept. Do not take etanercept if you are thinking of becoming pregnant in the near future or if you are not using contraception.
What about breastfeeding?
Do not breastfeed while on etanercept. The drug could pass into the breast milk and the risk to the baby is unknown.
Where can I obtain further information?
If you would like any further information about etanercept, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.
Remember to keep all medicines out of reach of children.
PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
