etanercept


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Related to etanercept: infliximab

etanercept

 [e-tan´er-sept]
a soluble tumor necrosis factor receptor that inactivates tumor necrosis factor, used in treatment of rheumatoid arthritis; administered subcutaneously.

etanercept

Enbrel

Pharmacologic class: Immunomodulator

Therapeutic class: Antiarthritic

Pregnancy risk category B

Action

Reacts with and deactivates free-floating tumor necrosis factor, responsible for inflammation

Availability

Powder for injection: 25 mg in multiple-use vial

Prefilled syringe (single-use): 50 mg/ml

Indications and dosages

Moderately to severely active rheumatoid arthritis; ankylosing spondylitis; psoriatric arthritis

Adults: 50 mg subcutaneously q week given as a single injection. Dosages above 50 mg/week are not recommended.

Chronic moderate to severe plaque psoriasis

Adults ages 18 and older: 50 mg subcutaneously twice weekly (given 3 or 4 days apart) for 3 months, followed by reduction to a maintenance dosage of 50 mg weekly

Polyarticular-course juvenile rheumatoid arthritis

Children ages 4 to 17: 0.8 mg/kg subcutaneously q week, to a maximum of 50 mg weekly

Contraindications

• Hypersensitivity to drug or its components
• Sepsis

Precautions

Use cautiously in:
• immunosuppression, chronic infection, heart failure
• latex allergy (needle cover of diluent syringe contains latex)
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 4.

Administration

• Inject subcutaneously into thigh, abdomen, or upper arm.
• For adult, use single-use, 50 mg/ml prefilled syringe.
• For child weighing 63 kg (138 lb) or more, use single-use, 50 mg/ml pre-filled syringe for weekly dose; for child weighing 31 to 62 kg (68 to 137 lb), administer total weekly dose from multipleuse vial as two injections on same day or 3 or 4 days apart; for child weighing less than 31 kg (68 lb), give as a single weekly injection using multipleuse vial.
• Rotate injection sites.

Adverse reactions

CNS: asthenia, headache, depression, dizziness, paresthesia, fatigue, demyelinating disorders (such as multiple sclerosis and myelitis), cerebral hemorrhage, seizures, cerebrovascular accident (CVA)

CV: hypotension, hypertension, chest pain, deep-vein thrombosis, thrombophlebitis, myocardial ischemia, myocardial infarction (MI), heart failure

EENT: ocular inflammation, pharyngitis, rhinitis, sinusitis

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, anorexia, cholecystitis, abdominal abscess, GI hemorrhage, intestinal perforation, pancreatitis

GU: pyelonephritis, membranous glomerulonephropathy

Hematologic: anemia, aplastic anemia, leukopenia, pancytopenia, thrombocytopenia

Metabolic: hypomagnesemia

Musculoskeletal: bursitis, polymyositis, joint pain

Respiratory: cough, congestion, dyspnea, bronchitis, pneumonia, pulmonary embolism, interstitial lung disease

Skin: flushing, cellulitis, pruritus, rash, cutaneous vasculitis, urticaria, alopecia, angioedema

Other: altered taste, weight gain, adenopathy, fever, irritation at injection site, peripheral edema, flulike symptoms, autoantibody formation, lupus-like syndrome, serious infections, malignancies

Interactions

None significant

Patient monitoring

Watch for signs and symptoms of malignancies, pancytopenia and infection.

Monitor for evidence of GI bleeding, lupus-like syndrome, and serious hypersensitivity reactions. Stop therapy immediately if these occur.
• Monitor CBC and coagulation studies.

Check for signs and symptoms of cardiac compromise and cerebrovascular events.
• Monitor pulmonary function test results periodically to assess lung status.
• Assess patient's ability to self-administer drug.
• Check for irritation at injection site. As needed, apply cool compresses.
• Examine eyes for conjunctival dryness. As needed, apply artificial tears.

Patient teaching

Tell patient to withhold dose and contact prescriber if he develops signs or symptoms of infection or is exposed to anyone with chickenpox.

Tell patient to immediately report hypersensitivity reaction, neurologic or respiratory problems, sudden weight gain, chest pain, or easy bruising or bleeding.
• Teach patient or caregiver how to administer drug and handle and dispose of equipment.
• Caution patient not to get live-virus vaccines.
• Tell female to inform prescriber if she is pregnant or breastfeeding.
• Advise patient to expect redness, swelling, and pain at injection site. Assure him that these problems will diminish over time.
• As appropriate, review all other significant and life-threatening adverse reactions mentioned above.

etanercept

/eta·ner·cept/ (e-tan´er-sept) a soluble tumor necrosis factor receptor that inactivates tumor necrosis factor, used in the treatment of rheumatoid arthritis.

etanercept

(ĭ-tăn′ər-sĕpt′)
n.
A drug that blocks tumor necrosis factor receptors and is used to treat autoimmune diseases, especially rheumatoid arthritis and psoriasis.

etanercept

a biological agent.
indication It is used to treat acute, chronic rheumatoid arthritis that has not responded to other treatments.
contraindications Known hypersensitivity and sepsis prohibit its use.
adverse effects Adverse effects include abdominal pain, dyspepsia, headache, asthenia, dizziness, injection site reaction, cough, upper respiratory infection, non-upper respiratory infection, and sinusitis. Common side effects include rash, pharyngitis, and rhinitis.

etanercept

Molecular medicine A genetically engineered molecule that blocks TNF activity, used to manage therapeutically refractive rheumatoid arthritis. See Rheumatoid arthritis.

etanercept

A fusion protein for the human tumour necrosis factor (TNF) receptor produced by recombinant DNA technology and engineered to block the action of TNA. It is used to treat RHEUMATOID ARTHRITIS. The drug has been claimed to relieve depression and fatigue in PSORIASIS. A brand name is Enbrel.

etanercept

cytokine inhibitor used to treat severe and/or non-responsive rheumatoid disease, active and progressive psoriatic arthropathy and severe ankylosing spondylitis
References in periodicals archive ?
Infliximab or etanercept in the treatment of children with refractory juvenile idiopathic arthritis: an open label study.
When these animals were treated with etanercept, it restored up to 60 percent of their responsiveness to morphine.
Results were supported by a subsequent phase III, 6-month, randomized, double-blinded, placebo-controlled trial comparing 2 doses of etanercept (10 and 25 mg SC BIW).
Patients who stopped infliximab because of toxicity did not experience any adverse events when switched to etanercept, she said.
The UNCOVER-2 and UNCOVER-3 clinical studies of more than 2,500 patients found ixekizumab to be statistically superior to etanercept and placebo on all measures of skin clearance.
The Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) (4) was also conducted in a double-blinded, three-arm, RCT fashion.
Etanercept is a tumor necrosis factor (TNF) inhibitor that has been shown to be effective and safe in the treatment of AS.
The rates were 24% with methotrexate, 48% with adalimumab, 34% with etanercept, 36% for ustekinumab, and 28% with NBUVB.
Both etanercept, which is a recombinant soluble human TNF receptor protein, and infliximab, which is a chimeric anti-TNF-[alpha] monoclonal antibody, have been used in psoriasis and PsA treatment successfully (4-6).
Currently, three of the new biologics have been approved by the Food and Drug Administration: etanercept (Enbrel), for psoriatic arthritis and rheumatoid arthritis (RA) in both adults and children; infliximab (Remicade), approved for Crohn's disease and RA; and most recently, alefacept (Amevive), which is the only one officially approved for psoriasis.
Similar clinical trial evidence supports the benefit of initial therapy with etanercept plus MTX compared with etanercept alone.