This clinical review outlines a practical approach to the use of etanercept in the treatment of psoriasis. Etanercept is FDA-approved for treatment of adult patients with chronic moderate-to-severe plaque psoriasis and psoriatic arthritis in addition to several other rheumatologic conditions. It is a recombinant fusion protein consisting of tumor necrosis factor-alpha (TNF-α) receptor components covalently linked to the Fc portion of IgG. Etanercept binds and inactivates TNF-α. The most common side effect associated with its use is mild to moderate injection-site reactions that usually do not require discontinuation of treatment. There is also likely some increased risk of infection and malignancy associated with this agent that one should consider when prescribing this medication.
TyringS., GordonK.B., PoulinY., LangleyR.G., GottliebA.B., DunnM., JahreisA.Long-term safety and efficacy of 50 mg of etanercept twice weekly in patients with psoriasis. Arch Dermatol.2007; 143(6): 719–26.
CDC. Guide for primary health care providers: targeted tuberculin testing and treatment of latent tuberculosis infection.
9.
Immunex Corporation. Enbrel® (etanercept): package insert (US) [online]. Available from URL: http://www.wyeth.com.
10.
DohertyS.D., VoorheesV., LebwohlM.G.National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents. J Am Acad Dermatol.2008; 59(2): 209–17.
11.
DesaiS.B., FurstD.E.Problems encountered during anti-tumour necrosis factor therapy. Best Pract Res Clin Rheumatol.2006; 20(4): 757–90.
12.
ZeinNN; Etanercept Study Group. Etanercept as an adjuvant to interferon and ribavirin in treatment-naive patients with chronic hepatitis C virus infection: a phase 2 randomized, double-blind, placebo-controlled study. J Hepatol.2005; 42(3): 315–22.
13.
PetersonJ.R., HsuF.C., SimkinP.A., WenerM.H.Effect of tumour necrosis factor alpha antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection. Ann Rheum Dis.2003; 62(11): 1078–82.
14.
LeonardiC.L., PowersJ.L., MathesonR.T., GoffeB.S., ZitnikR., WangA., GottliebA.B.Etanercept as monotherapy in patients with psoriasis. N Engl J Med.2003; 349(21): 2014–22.
15.
BrownS.L., GreeneM.H., GershonS.K., EdwardsE.T., BraunM.M.Tumor necrosis factor antagonist therapy and lymphoma development: twenty-six cases reported to the Food and Drug Administration. Arthritis Rheum.2002; 46(12): 3151–8.
16.
AsklingJ., ForedC.M., BrandtL., BaecklundE., BertilssonL., FelteliusN., CösterL., GeborekP., JacobssonL.T., LindbladS., LysholmJ., Rantapää-DahlqvistS., SaxneT., KlareskogL.Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Ann Rheum Dis.2005; 64(10): 1421–6.
17.
PappK.A., TyringS., LahfaM., PrinzJ., GriffithsC.E., NakanishiA.M., ZitnikR., van de KerkhofP.C., MelvinL; Etanercept Psoriasis Study Group. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br J Dermatol.2005; 152(6): 1304–12.
18.
WolfeF., MichaudK.Biologic treatment of rheumatoid arthritis and the risk of malignancy: analyses from a large US observational study. Arthritis Rheum.2007; 56(9): 2886–95.
19.
StoneJ.H., HolbrookJ.T., MarriottM.A.Solid malignancies among patients in the Wegener's Granulomatosis Etanercept Trial. Arthritis Rheum.2006; 54: 1608–18.
20.
MenterA., GottliebA., FeldmanS.R.Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 1: Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol.2008; 58(5): 846–50.
21.
[LMS-UBC] The Lenercept Multiple Sclerosis Study Group, and The University of British Columbia MS/MRI Analysis Group. TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. Neurology.1999; 53: 457–65.
22.
DayR.Adverse reactions to TNF alpha inhibitors in rheumatoid arthritis. Lancet.2002; 359: 540–1.
23.
Sanchez CarazoJ.L., SantosL.M., MartinezV.O.Safety of etanercept in psoriasis: a critical review. Drug Saf2006; 29(8): 675–85.
24.
KwonH.J., CoteT.R., CuffeM.S.Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med.2003; 138(10): 807–
25.
WolfeF., MichaudK.Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am J Med.2004; 116: 305–11.
26.
ColeJ., BustiA., KaziS.The incidence of new onset congestive heart failure and heart failure exacerbation in veteran's affairs patients receiving tumor necrosis factor alpha antagonists. Rheumatol Int.2007; 27(4): 3.
27.
BozkurtB., Torre-AmioneG., WarrenM.S., WhitmoreJ., SoranO.Z., FeldmanA.M., MannD.L.Results of targeted anti-tumor necrosis factor therapy with etanercept (ENBREL) in patients with advanced heart failure. Circulation.2001; 103(8): 1044–7.
28.
MeaseP.J., RitchlinC.T., MartinR.W., GottliebA.B., BaumgartnerS.W., BurgeD.J., WhitmoreJ.B.Pneumococcal vaccine response in psoriatic arthritis patients during treatment with etanercept. J Rheumatol.2004; 31(7): 1356–61.
29.
GelinckL.B., van der BijlA.E., BeyerW.E., VisserL.G., HuizingaT.W., van HogezandR.A., RimmelzwaanG.F., KroonF.P.The effect of anti-tumour necrosis factor alpha treatment on the antibody response to influenza vaccination. Ann Rheum Dis.2008; 67(5): 713–6.
30.
GoldsmithD.R., WagstaffA.J.Etanercept: a review of its use in the management of plague psoriasis and psoriatic arthritis. Am J Clin Dermatol.2005; 6(2): 121–36.
