Etanercept for rheumatoid arthritis
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Etanercept is given as a shot under the skin (subcutaneous injection).
How It Works
Etanercept reduces the effects of tumor necrosis factor (TNF). TNF is a protein that attaches to the joint surface and causes inflammation and joint damage. Etanercept blocks the action of TNF and reduces symptoms and slows the progression of rheumatoid arthritis.
Etanercept is a disease-modifying antirheumatic drug (DMARD), which means it slows the progression of the disease. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).
Why It Is Used
Etanercept is used to treat severe rheumatoid arthritis when other medications have not been effective. It also may be used in combination with methotrexate.
How Well It Works
Etanercept works quickly with minimal side effects. It appears to affect disease activity within weeks. When used alone or in combination with methotrexate, it decreases pain and swelling better than methotrexate alone.1 Combining etanercept with methotrexate has produced good results, greatly slowing damage to joints while increasing functional ability.2
Etanercept is effective in relieving joint pain and swelling in rheumatoid arthritis that has not improved with methotrexate or other DMARDs.3
The most common side effect of TNF antagonists such as etanercept is an allergic reaction to the injection (shot). If you have a reaction to the shot, it will happen right away, either during the shot or within 1 to 2 hours after the shot. Your doctor may give you medicines to prevent or stop the reaction.
Symptoms of a reaction to the shot include:
- Chest pain.
- Shortness of breath.
- Itching (pruritus).
- Heat and redness (flushing) in the face.
Warnings about serious side effects of TNF antagonists have been issued. The U.S. Food and Drug Administration (FDA) and the drug’s manufacturers have warned about:
- An increased risk of a serious infection. TNF antagonists affect your body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
- An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
- A possible increased risk of lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk. There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking TNF antagonists, that often results in death.
- An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have a fever or dark brown urine.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Etanercept is expensive; it may cost significantly more than other DMARDs.1
Etanercept should not be used by pregnant women or women of childbearing age who are not using reliable birth control. If you are going to take etanercept, you should be on some form of reliable birth control. If you plan to become pregnant, check with your health professional before stopping birth control and trying to become pregnant.
Etanercept is a relatively new medicine. Its long-term safety and effectiveness are not fully known.4
Etanercept can be self-administered once you receive training and instructions from your health professional.
- Blumenauer B, et al. (2007). Etanercept for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews (4).
- Klareskog L, et al. (2004). Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: Double-blind randomised controlled trial. Lancet, 363(9410): 675–681.
- Kremer JM (2001). Rational use of new and existing disease-modifying agents in rheumatoid arthritis. Annals of Internal Medicine, 134(8): 695–706.
- Walker-Bone K, Fallow S (2007). Rheumatoid arthritis, search date June 2005. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Last Updated: August 18, 2008