Etanercept (Enbrel)

Etanercept is an anti TNF (anti-tumour necrosis factor) drug which has been approved by NICE for AS.

Etanercept is only available on prescription from a consultant rheumatologist.

Etanercept is given by an injection under the skin (subcutaneous injection) 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 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 you will probably feel better in 2-12 weeks.

Possible risks or side effects

Etanercept may cause a blocked or runny nose, headache, dizziness, rash, stomach pain or indigestion. You may also 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. You should tell your doctor or rheumatology nurse straight away if you develop any of the following after starting etanercept:

  • a sore throat
  • a fever
  • any other symptoms of infection
  • 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. Therefore you may need antiviral treatment, which your doctor will be able to prescribe.

Very rarely, people taking etanercept may develop a condition called drug-induced lupus, which is usually mild. The symptoms are a rash, fever and increased joint pain. Your doctor will check for this with a blood test. If you develop drug-induced lupus, the etanercept will be stopped and the condition usually then disappears.

It is possible that there may be a slightly increased risk of certain types of cancer in patients using anti-TNF drugs. Such a link has not been proven but is the subject of current research. Please discuss this with your doctor if you are concerned.

Anti-TNF drugs have been associated with certain types of skin cancer - these can be treated when diagnosed early.

As yet, the long-term side-effects of etanercept are not fully understood because it is a relatively new drug.

Reducing the risk of infection

Because of its effects on the immune system, etanercept may make you more more likely to pick up food-borne infections such as salmonella and listeria, which can result in food poisoning and other serious illnesses. You can lower this risk by avoiding foods such as:

  • raw eggs or products made from raw eggs (such as mayonnaise, although many commercially available products are likely to be 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 make sure that chilled ready meals are thoroughly cooked before eating. For further advice see the NHS Choices web page on food safety.

Checks needed 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.

Taking other medicines along with etanercept

Etanercept may be prescribed alongside other medications. 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 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.

If you are 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 (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines are safe and recommended.

Etanercept and surgery

If you are going to have an operation please inform your doctor, as you may be advised to stop the etanercept temporarily before and after surgery.

Etanercept and fertility or pregnancy

No-one knows the risk of etanercept to an unborn baby. Women of childbearing age therefore must use contraception while on etanercept. You should not take etanercept if you are thinking of becoming pregnant in the near future or if you are not using contraception.

You should not breastfeed if you are on etanercept. The drug may pass into the breast milk and could be harmful to your baby.

Etanercept and travelling

When travelling by land or air, etanercept should be transported in a cooler with ice packs to maintain a temperature of 2-8 degrees centigrade. The manufacturer of etanercept currently do not endorse or recommend any specific containers for transporting etanercept at the required temperature. During air travel, you should carry your etanercept on board with you. Etanercept should not be packed in a checked suitcase due to the uncertainty of maintaining an appropriate temperature and the risk of lost luggage.

Etanercept stability is not affected by exposure to x-ray machines used at airports for screening carry-on luggage.

Prior to departure, check with the airlines regarding regulations of the departing and destination countries regarding the transportation of prescription medications, including syringes.

Once you have arrived at your destination, etanercept should continue to be kept at the recommended storage temperature (2-8 degrees centigrade). A refrigerator in a hotel room or replacing the ice packs should maintain an appropriate temperature.

The used syringe should be immediately thrown away in a puncture-resistant container. A container made specifically for disposing of used syringes and needles (a sharps container) may be used.


Last reviewed: October 2010


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