Prophylactic Etanercept Treatment

Overview

Etanercept is a drug used to treat and manage autoimmune diseases like juvenile idiopathic arthritis, ankylosing spondylitis, plaque psoriasis, rheumatoid arthritis, and psoriatic arthritis. It belongs to the group of drugs known as TNF inhibitors and is a biological fusion protein.

Prophylactic vs Therapeutic

Prophylactic treatment is a preventive action. The term, which means an advance guard in Greek, is fitting for describing a step done to fend off a sickness or another undesirable outcome. A prophylactic is a drug or treatment that is used to prevent the disease from developing. For instance, Sydenham's chorea can be avoided by using prophylactic antibiotics following a case of rheumatic fever. A prophylactic is also a medication or device, most notably a condom, used to avoid becoming pregnant.

Therapeutics are treatment and care that are provided to a patient to treat or prevent disease, reduce pain, or heal an injury. The name of the concept is therapeutikos, a Greek word that means inclined to serve.

Therapeutics, in its broadest sense, refers to the provision of comprehensive patient care, including both the management of specific issues and the prevention of disease. Therefore, both the prevention and management of disease processes depend on factors such as exercise, food, and mental health. The use of medications to treat pain or infections, a surgical procedure to remove diseased tissue or replace organs with fully functional ones, and counseling or psychotherapy to ease emotional distress are some of the more specialized treatments used to address specific symptoms. Effectiveness is increased when patients have confidence in the doctor and the treatment plan.

Prophylactic Etanercept

The treatment of patients with psoriasis with persistent HCV infection is difficult. Interferon (IFN)-alpha for the treatment of HCV can exacerbate psoriasis, and treating systemic psoriasis with methotrexate and acitretin can be hepatotoxic. Patients with psoriasis and HCV can benefit from using etanercept. In an HCV patient receiving IFN-alpha and ribavirin treatment, etanercept can be given as a prophylactic measure to avoid a psoriatic flare.

Etanercept MOA

Etanercept is a biological TNF inhibitor that binds to both TNF-alpha and TNF-beta and functions as a soluble TNF receptor. TNF is a cytokine that has a role in inflammation and the immune response and can bind to either TNF receptor 1 (TNFR1) or TNF receptor 2 (TNFR2). TNF activates critical inflammatory pathways, including NFkB and MAPK, by binding to TNFR1 or TNFR2. Two p75 TNF receptors are linked to the Fc region of human IgG to form the structure of etanercept. TNF-alpha, a pro-inflammatory cytokine that is raised in conditions like psoriasis, rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis, is what Etanercept does. Etanercept works by blocking this cytokine's effects.

Etanercept Indications

A biologic TNF inhibitor called etanercept is frequently prescribed to treat conditions like juvenile idiopathic arthritis, plaque psoriasis, psoriatic arthritis, and rheumatoid arthritis. Etanercept is a soluble receptor that binds to both TNF-alpha and TNF-beta to prevent the inflammatory reaction that is typical of these autoimmune illnesses in the skin and joints. The medication can be used alone or in combination with other immunosuppressants like methotrexate. Etanercept is a medication that doctors can use for both on-label and off-label purposes. FDA-licensed uses include:

• Ankylosing spondylitis
• Juvenile idiopathic arthritis
• Plaque psoriasis
• Psoriatic arthritis
• Rheumatoid arthritis

Non-approved uses (off-label uses) include the following:

• Acute graft-versus-host disease
• Behcet's disease
• Hidradenitis suppurativa
• Kawasaki disease
• Pemphigus Vulgaris
• Pustular psoriasis
• Pyoderma gangrenosum
• Systemic sclerosis
• Still disease

Etanercept Contraindications

Sepsis patients are contraindications for etanercept. Etanercept should not be started in patients with active bacterial infections, such as active or latent tuberculosis, active herpes zoster, active or long-term untreated Hepatitis B or C, or active invasive fungal infections. If a patient has hypersensitivity reactions to the medication's constituents, they shouldn't use etanercept.

Etanercept Dosing

Your Etanercept dosage will vary depending on the condition you're trying to treat as well as other factors. Your age, weight, and any additional medical conditions you may have are a few examples. Your doctor may start your therapy with a specific dose and gradually increase it until it is exactly perfect for you. In the end, your doctor will recommend the smallest dose that produces the desired result. The dosages that are frequently used or suggested are described below. But make sure to follow the dose instructions provided by your doctor. The ideal dosage will be chosen by your doctor based on your needs.

Rheumatoid Arthritis Dosage

Adults with rheumatoid arthritis (RA) are commonly treated with 50 mg of injections of Etanercept once a week. Methotrexate together with Etanercept may be given to some RA patients. If you need to take methotrexate, your doctor will decide. They'll also demonstrate how to administer the Etanercept injection on your own.

Psoriatic Arthritis Dosage

Adults with psoriatic arthritis often take 50 mg of Etanercept once weekly. Your doctor might advise combining Etanercept with methotrexate depending on your symptoms. If you need to take methotrexate, your doctor will decide. They'll also demonstrate how to administer the Etanercept injection on your own.

Plaque Psoriasis Dosage

Enbrel's standard initial dose, also known as a loading dose, is 50 mg administered twice weekly for three months for individuals with plaque psoriasis. To assist your body to respond to treatment more quickly, your doctor will start you on this higher dose. Your doctor will reduce your dosage to 50 mg administered once each week after three months.

Instead of a twice-weekly starting dose, your doctor may occasionally prescribe a lower 25-mg or 50-mg dose provided once per week. Your illness and other health-related factors will play a role in this. The ideal dosage for you will be chosen by your doctor, who will also gradually alter it as needed.

Ankylosing Spondylitis Dosage

Etanercept is often started at a 50 mg injection once per week for ankylosing spondylitis. Your doctor may recommend additional medications, such as methotrexate, in addition to Etanercept for this disease.

Adolescent Idiopathic Polyarticular Arthritis Dosage

Etanercept can be used to treat polyarticular juvenile idiopathic arthritis in children aged 2 to 17 years. The dose is determined by weight:

• The usual dosage for kids who weigh 138 pounds (lb.) or more is 50 mg administered once per week.
• The dosage for kids under 138 lb. is 0.8 mg per kg administered once per week. The ideal dosage will be determined by a pharmacist or your child's doctor.

Etanercept Dosage for Children

Plaque psoriasis in children between the ages of 4 and 17 can be treated with Enbrel. The dose is determined by weight:

• The usual dosage for kids who weigh 138 lb. or more is 50 mg administered once per week.
• The normal dosage is 0.8 mg per kg of body weight given once per week to children who weigh less than 138 lb. The ideal dosage will be determined by a pharmacist or your child's doctor.

Etanercept Administration

Etanercept is administered by subcutaneous injection, typically in the upper arm, lower belly, or thigh. The injection shouldn't be placed inside the 2-inch circle around the navel if it's given on the abdomen. A minimum of 1 inch should separate new injection sites from old injection sites. The drug is packaged as a multiple-dose vial, automatic injection tool, or pre-filled syringe. After receiving the initial etanercept injection at the doctor's office, the patient can self-inject at home with the right training. 50 mg of etanercept is given once per week to treat ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis. A different dose schedule involves administering 25 mg subcutaneously twice each week with a minimum of 72 to 96 hours in between injections. The recommended dosage for psoriasis is 50 mg twice weekly for three months, then 50 mg once weekly. Juvenile idiopathic arthritis patients receive up to 50 mg of 0.8 mg/kg once a week.

How to Use Etanercept?

Etanercept is injected directly beneath the skin (called subcutaneous injection). Some people can administer the injection themselves, while others can have it administered by a family member, friend, doctor, or nurse after receiving the appropriate training. Ask your doctor, nurse, or pharmacist to demonstrate how to inject Etanercept if you are uncertain how to use it.

• Preparation. Etanercept is often kept in the refrigerator. Before injecting, remove it from the refrigerator and let it sit at room temperature for 15 to 30 minutes. Etanercept must not be prepared in any other way, such as in a microwave or with hot water.
• Injection sites. Choose an injection site that is at least 5 cm away from your belly buttons, such as the front of your thighs or your abdomen (belly). At least 3 cm should separate the injection site from where you just had one. Never inject into hurting, bruised, red, hard, scarred, stretch mark- or psoriasis plaque-covered skin.

Etanercept Monitoring

Patients should be checked for any infections, such as latent tuberculosis or hepatitis B, before beginning etanercept. Etanercept users must be examined for symptoms of infection, the reactivation of tuberculosis, and the development of hepatitis B and tuberculosis. Stop using etanercept if serious infection or sepsis appears while you're taking it. Patients should also be kept an eye out for any signs or symptoms of lupus-like disease, malignancy, or hypersensitivity reactions. Patients receiving etanercept therapy also need to be watched closely if they have a history of heart failure.

Etanercept Adverse Effects

These common negative effects include:

• Infections (viral, bacterial, and fungal – primarily upper respiratory tract infections)
• Reaction at the injection site (redness, itching, pain, swelling, bleeding, bruising)

Rare negative consequences include:

• Blood and lymphatic illnesses. Aplastic anemia, leukopenia, myelodysplastic syndrome, neutropenia, pancytopenia, and thrombocytopenia.
• Cancers. skin cancers and lymphoma
• Cardiopulmonary problems. interstitial lung disease and congestive heart failure.
• Liver and digestive problems, including autoimmune hepatitis, nausea, increased transaminases, diarrhea, and inflammatory bowel disease.
• Blood and lymphatic illnesses. Angioedema, hypersensitivity reactions, lupus-like syndrome, non-neutralizing anti-Etanercept antibodies, pyrexia, sarcoidosis, uveitis, and vasculitis are examples of immune and inflammatory diseases.
• Infectious diseases. Legionella pneumonia, listeriosis, nocardiosis, pneumocystis pneumonia, reactivation of Hepatitis B or TB, salmonella infection, septic arthritis, herpes zoster, histoplasmosis, coccidioidomycosis, cryptococcus,
• Disorders of the nervous system include headache, transverse myelitis, multiple sclerosis, optic neuritis, paresthesia, and seizures.
• Skin conditions include toxic epidermal necrolysis, urticaria, cutaneous lupus erythematosus, erythema multiforme, new or worsening psoriasis, rash, and Stevens-Johnson syndrome.

US Boxed Warnings

• Infections

Etanercept users are more likely to develop serious and/or deadly infections, including active tuberculosis or the reactivation of latent tuberculosis. Numerous bacterial, viral, and fungal infections, such as invasive fungal (aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, histoplasmosis, and pneumocystis), as well as opportunistic infections (legionellosis, listeriosis), have been reported.

Patients who took additional immunosuppressive drugs, including corticosteroids or methotrexate, had a higher incidence of infections. Etanercept should be prescribed with caution for patients who are at higher risk for infections, such as the elderly, immunocompromised, those who have a history of recurrent/chronic/opportunistic infections, as well as those who have been exposed to tuberculosis or endemic mycoses. When treating patients who reside in or are visiting endemic regions where there is a higher risk of developing invasive fungal infections, doctors should think about empiric antifungal medication.

• Malignancies

There have been reports of malignancies in people receiving etanercept, particularly in kids and teenagers. The most often reported cancers were lymphomas, followed by melanoma and other skin cancers. Clinical trials and case reports revealed an elevated prevalence of lymphoma and other malignancies in individuals on etanercept when compared to the general population, even though the relationship between etanercept and malignancies is not entirely understood. It is important to remember that rheumatoid arthritis alone has links to higher rates of lymphoma and leukemia.

Etanercept Toxicity

Clinical trials, in vivo studies, and in vitro experiments have not revealed any dose-limiting toxicities. The treatment with etanercept may be toxic over the long term, however, this is unknown.

Improving Healthcare Team Outcomes

Plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis can all be treated with etanercept among other medications. Etanercept's potential hazards and advantages should be compared, along with the drug's price, efficiency, mode of administration, and side effects. Etanercept is a biologic, so using it can have major adverse effects including infections, cancer, and autoimmune diseases.

To ensure the patient's safety and wellbeing, an interprofessional team of physicians, experts, nurses, and pharmacists must collaborate. Clinicians should be aware of the treatment recommendations before opting to use etanercept, including monitoring the patient for heart failure, TB, hepatitis B, and other infections both before and during treatment. Clinicians and nurses will give instructions on how to correctly deliver etanercept injections at home to the patient or the patient's family. The patient must be given the appropriate prescription and dosage, as well as information about drug interactions and negative side effects, according to pharmacists and clinicians. Nursing can engage in education and training related to injectable administration and should inform the team of any bad effects as well as record the success or failure of treatment. Additionally, etanercept biosimilars have been entering the market, thus healthcare professionals must be informed about all of their available therapeutic alternatives. Patients with these disorders have a poor quality of life if not well managed. A multidisciplinary healthcare team can assist in achieving the greatest results while minimizing unfavorable events.

Conclusion

Etanercept is a drug that is administered through subcutaneous injection (an injection under your skin). There are several dosages and strengths of the medication. You might receive Etanercept injections at your physician's office when you first start taking the medication. Then they will demonstrate how to administer shots on your own at home. Asking your pharmacist to demonstrate how to take Etanercept is another option.