Etanercept is an anti TNF which has been approved by NICE for AS and non radiographic axial spondyloarthritis.
The originator product was Enbrel and a biosimilar version called Benepali has now been launched onto the market.
Etanercept is only available on prescription from a consultant rheumatologist.
It is taken once or twice a week as an injection under the skin. It comes in either a 'pen' device or in a pre-filled syringe. 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 get from your doctor or rheumatology nurse. Then if you become unwell, anyone treating you will know that you are on etanercept and that you are therefore at risk of its side-effects, including infections.
Time etanercept takes to work
If you respond to etanercept your symptoms will start to improve in 2-12 weeks.
Possible side effects
The most common side effects of etanercept are:
- blocked or runny nose
- stomach pain or indigestion
- feeling sick
- mild fever
- 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. Avoid close contact with people with infections and be extra careful with food safety.
You should tell your doctor or rheumatology nurse straight away if you develop any of the following:
- sore throat
- any other symptoms of infection such as coughing up green phlegm or diarrhoea
- unexplained bruising, bleeding or paleness
- any other new symptoms or anything else that concerns you.
You should stop etanercept and see your doctor immediately if:
- any of the symptoms listed above are severe
- you have not had chickenpox and you come into contact with someone who has chickenpox or shingles
- you develop chickenpox or shingles.
Chickenpox and shingles can be severe in people who are on treatments such as etanercept which affect the immune system. You may need antiviral treatment, which your doctor will be able to prescribe and you will need to stop etanercept until you are better.
Potential risks associated with etanercept
There may be a slightly increased risk of some cancers with etanercept as it interferes with the immune system. This is theoretically possible because the immune system is involved in recognising and killing cancerous cells. It's important to bear in mind that this link hasn't been proven and is still being extensively researched. A a review in 2012 of studies involving over 25,000 patients found no increase in the risk of cancer.
Very rarely, people taking etanercept may develop a condition called drug induced lupus. This is usually mild and can be diagnosed by a blood test. Symptoms include a rash, fever and increased joint pain. If you develop drug-induced lupus, the etanercept will be stopped and the condition then usually disappears.
If you're taking etanercept it's recommended that you avoid live vaccines such as yellow fever. If you do need a live vaccine do discuss all the possible risks and benefits of the vaccination with your doctor.
If you're in your 70s your doctor may advise you to have the shingles vaccination (Zostavax) before starting etanercept. This vaccination is not recommended for people who are already on etanercept.
Pneumovax (pneumonia) and yearly flu vaccines are recommended for everyone on etanercept.
Etanercept may be prescribed along with other medicines. Do discuss any new medications with your doctor before starting them, and always tell any doctor treating you that you are on etanercept.
Etanercept is not a painkiller. If you are already on a non-steroidal anti inflammatory drug (NSAID) or painkillers you can carry on taking these as well as etanercept, unless your doctor advises otherwise.
Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.
There is no known interaction between etanercept and alcohol.
Etanercept and surgery
If you are going to have an operation please inform your doctor, as you are likely to be advised to stop the etanercept temporarily before and after surgery.
Etanercept and fertility or pregnancy
The British Society for Rheumatology produced new guidelines on the use of anti TNF therapy such as etanercept during pregnancy.
Etanercept and travelling
If you are travelling abroad and taking your anti TNF therapy with you, it's important to make plans to keep it at the correct temperature during the journey and at your destination. You can buy special cool bags and even travel fridges. A useful company to try to purchase these products is MedActiv.
Another option is to use a Frio wallet or carry case. These are designed to keep insulin cool but work well for anti TNF. You can buy these through Amazon.
In addition to your anti TNF medication you may require a travel size sharps box. Do discuss this with your Clinical Nurse Specialist or your delivery team.
There's more travel tips in the `Living with AS` section of the website.
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