- Etanercept is a fusion protein consisting of two tumor necrosis factor (TNF) receptors linked to the Fc protein of human immunoglobulin (IgG). It works by inhibiting the pro- inflammatory action of TNF in psoriasis.
- Patients inject the medication subcutaneously, with dosing either at 50 mg weekly (either as a single dose or divided into two doses) or 50 mg twice a week for 12 weeks followed by a decrease to the 50 mg weekly maintenance dosing. The regimen with higher initial dosing has been shown to clear psoriatic lesions faster, however a recent study has shown that patients on both dosing schedules achieve the same endpoint at oneyear. Thus, consideration should be made to dose patients starting at 50 mg weekly, which is less costly and achieves the same result at one year.
- A common side effect of etanercept is a transient injection reaction. More serious rare reactions include serious infections (including tuberculosis), demyelinating disease, aplastic anemia, and an increased incidence of malignancy.
- With incomplete response to etanercept, it may be combined with other therapies including NB-UVB, acitretin, or methotrexate. Incomplete responses or failures may necessitate a switch to infliximab, adalimumab, or ustekinumab.
- Some studies have suggested that some patients treated with etanercept may lose efficacy over time. If a previously stable patient on etanercept flares, cyclosporine may be used temporarily to control the disease.
Kalb. R 2013 (07) – Kalb. R. Treatment of Psoriasis in the Age of Biologics – 25th Annual Scientific Meeting of the Dermatological Society of Singapore (DSS) – Singapore
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