| TNF alpha is a cytokine, a protein that is produced | | | | is given as a subcutaneous injection. Dosing will vary |
| during the inflammatory response. TNF alpha is | | | | according to disease severity and body size. |
| involved in inflammation from two perspectives. It is not | | | | Because etanercept reduces the immune response, it |
| only the product of inflammation; it also helps | | | | should not be administered with live vaccines. |
| perpetuate and promote inflammation. Increased levels | | | | Etanercept is not recommended for use in pregnant or |
| of TNF are found in several inflammatory conditions | | | | nursing women. |
| including rheumatoid arthritis, psoriatic arthritis, and | | | | The most common side effects are mild to moderate |
| ankylosing spondylitis. Drugs that block tumor necrosis | | | | itching, pain, swelling and redness at the site of injection. |
| factor (TNF) have been found to be particularly | | | | Headache, dizziness, nose and throat irritation also |
| effective for the treatment of these serious forms of | | | | occur. |
| inflammatory arthritis. | | | | TNF alpha has an important role in the response of the |
| The first anti-TNF drug approved for such use was | | | | immune system to infections. Blocking the action of |
| etanercept (Enbrel). | | | | TNF alpha with etanercept may worsen or increase |
| Etanercept is a synthetic (man-made) protein that | | | | the occurrence of infections, and patients with serious |
| binds to TNF alpha. It acts like a sponge to remove | | | | infections should not receive etanercept. Etanercept |
| most of the TNF alpha molecules from the joints and | | | | should be discontinued if a patient develops a serious |
| blood. This prevents TNF alpha from perpetuating | | | | infection. It should not be given to patients with active |
| inflammation and the pain, tenderness and swelling of | | | | infections or who have an allergy to its components. |
| joints in patients with different types of arthritis. | | | | Etanercept should be used with caution in patients |
| Etanercept reduces the signs and symptoms of | | | | prone to infection, such as those with poorly controlled |
| rheumatoid arthritis, the arthritis of psoriasis, and | | | | diabetes. |
| ankylosing spondylitis. It also prevents the progression | | | | Since etanercept has entered the market, there have |
| of joint destruction in patients with rheumatoid arthritis | | | | been reports of multiple sclerosis, myelitis, optic neuritis |
| and the arthritis of psoriasis. | | | | in patients using the drug. Etanercept is not |
| Etanercept is usually used in combination with | | | | recommended for persons with preexisting disease of |
| methotrexate in patients who do not respond | | | | the central nervous system (brain and/or spinal cord) |
| adequately to methotrexate alone. | | | | or for those with multiple sclerosis, myelitis, or optic |
| Etanercept comes in two different preparations. The | | | | neuritis. Rare cases of potentially serious low blood |
| first is a powder that must be reconstituted (mixed) | | | | counts (pancytopenia) have been reported in patients |
| with a diluent. This comes as a 25 mg dose. The | | | | using etanercept. |
| second is as a premixed syringe containing 50 mgs of | | | | Monitoring should be done according to guidelines set |
| etanercept. Etanercept must be refrigerated. The drug | | | | by the rheumatologist. |