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Contents

Etanercept (Enbrel)


Whilst the risk of extra infection can be reduced by keeping up to date with vaccinations, it is important to know that not all vaccinations can be given when on this drug. Inactivated (killed) vaccines such as influenza are fine (and indeed very important) to have. Live attenuated vaccines (such as yellow fever), should be avoided as they may be unsafe. Patients on etanercept should inform their doctor that they are taking this drug before receiving any vaccine.
If you are taking etanercept and have come into contact with someone having chickenpox or shingles, you may be more likely to contract this condition than others would be. If you develop any symptoms it will be important to contact your doctor to have a course of anti viral drugs starting as soon as possible.
As well as being important in fighting infection, TNFα is potentially important in the body’s defence against cancer. It is theoretically possible, therefore, that suppressing this chemical may result in a higher chance of developing cancer. However, over the many years of experience with etanercept and the other anti-TNFα drugs, there have been isolated reports, but not firm and consistent evidence for a greater incidence of cancer developing than would have been expected if patients were not taking this drug. This is something that registries, such as The British Society of Rheumatology Biologics Register (BSRBR) will help answer (The BSRBR register tracks the progress of patients with severe rheumatoid arthritis (RA), who are receiving biologic agents, monitoring the safety and effectiveness of these treatments over a long-term period). At present, whilst there is no strong evidence to suggest an increased risk of cancers or other tumours, rheumatologists are advised not to start this drug in patients who are currently being treated for, or have recently had, a cancer.

NICE approval

The UK National Institute for Health and Clinical Excellence (NICE) has approved the use of etanercept as a cost-effective therapy for RA (after failure or intolerance to two DMARDs including methotrexate and high disease activity), juvenile idiopathic arthritis, ankylosing spondylitis, psoriasis and psoriatic arthritis. Many other countries around the world allow etanercept and other TNFα inhibitors to be used in patients with less severe RA and also earlier in the course of the disease.

Advice on travelling when taking etanercept

Before travelling abroad, it is very important to keep up to date with vaccinations – but remember to avoid live vaccines. Etanercept can now be stored at room temperature (up to 25°C) for a single period of up to 4 weeks, making it much easier to carry when travelling by air. However, it should not be refrigerated after this. The company who provide your medication may be able to offer you more information on travelling with etanercept.

Planning surgery

If you have an operation planned, you should contact your rheumatologist who can advise you as to when to stop your etanercept prior to the operation. This can depend upon the type of operation planned. If you need an emergency operation and are taking etanercept, you should not worry, as the risk of not having the operation is likely to be far worse than a small risk of infection that may occur when on etanercept. The most important thing is to tell your surgeon about your medication.

Alcohol:

It is not generally a problem to drink alcohol whilst on etanercept. However, some people taking this drug will also be on other medications, such as methotrexate, in which case the consumption of alcohol should be limited.

Pregnancy and breastfeeding:

Reports of unexpected pregnancies while on etanercept suggest the outcome of the pregnancy for both mother and baby is just the same as when this drug has not been taken. However, no one really knows the risk of etanercept to an unborn baby. If you are thinking of becoming pregnant in the near future or if you are not using contraception, you should discuss the most appropriate treatment options with your rheumatology team. The drug manufacturer does not recommend taking etanercept whilst breastfeeding and suggests that breastfeeding should only take place after being off the drug for at least 6 months.

Further reading:

NRAS booklet: Biologics, The story so far
NRAS article: Anti TNF Treatment

References available on request

Professor Robert J Moots BSc (hons) MBBS (hons) PhD FRCP, Professor of Rheumatology, University Hospital Aintree, University of Liverpool

Original article: 24/08/2004
Reviewed: 09/09/2013
Next review due: 09/09/2016

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