What is the typical dose and administration schedule for Etanercept (Enbrel) in treating rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis?

From the Guidelines

Etanercept (Enbrel) is typically administered at a dose of 50 mg once weekly by subcutaneous injection for adults with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, while for plaque psoriasis, the initial recommended dose is 50 mg twice weekly for the first 12 weeks, followed by a maintenance dose of 50 mg once weekly. This dosing regimen is based on the most recent and highest quality study available, which is the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics 1.

Key Considerations

• The medication comes as a prefilled syringe, autoinjector pen, or powder for reconstitution, and should be stored in the refrigerator but brought to room temperature before injection.
• Patients should rotate injection sites between the thigh, abdomen, and upper arm to prevent injection site reactions.
• Etanercept works by binding to tumor necrosis factor (TNF), a key inflammatory cytokine, thereby reducing inflammation and associated symptoms in these autoimmune conditions.
• Before starting treatment, patients should be screened for tuberculosis and other infections, as etanercept can increase infection risk by suppressing the immune system.

Dosing for Specific Conditions

• For rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, the recommended dose is 50 mg once weekly.
• For plaque psoriasis, the initial dose is 50 mg twice weekly for the first 12 weeks, followed by 50 mg once weekly thereafter.
• Pediatric dosing is weight-based, with children weighing 63 kg or more receiving the adult dose, while those weighing less receive 0.8 mg/kg weekly (up to a maximum of 50 mg) 1.

Important Safety Information

• Etanercept can increase the risk of serious infections, including tuberculosis, and patients should be screened for these infections before starting treatment 1.
• The medication should be used with caution in patients with a history of recurrent infections or those who are prone to infections.

From the Research

Typical Dose and Administration Schedule for Etanercept (Enbrel)

The typical dose and administration schedule for Etanercept (Enbrel) in treating various conditions are as follows:

• Rheumatoid arthritis:
  • Subcutaneous etanercept 25mg twice weekly or 50mg once weekly 2, 3, 4
  • Etanercept plus methotrexate combination therapy is generally superior to either monotherapy in reducing disease activity and structural joint damage 3
• Psoriatic arthritis:
  • Subcutaneous etanercept 25mg twice weekly 2, 4, 5, 6
  • Etanercept can reduce the signs and symptoms of psoriatic arthritis and inhibit radiographic progression in studies with follow-up periods of up to 2 years 6
• Ankylosing spondylitis:
  • Subcutaneous etanercept 25mg twice weekly or 50mg once weekly 2
  • Monotherapy with etanercept was effective and generally well tolerated in patients with ankylosing spondylitis 2
• Plaque psoriasis:
  • Subcutaneous etanercept 25mg twice weekly or 50mg once weekly 3
  • Etanercept is effective in the treatment of psoriatic arthritis and plaque psoriasis, with a favorable risk-benefit profile in the short term 6

Efficacy and Safety

The efficacy and safety of etanercept in these conditions have been demonstrated in several studies:

• Etanercept was more effective than placebo in reducing disease activity and improving health-related quality of life (HR-QOL) in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis 2, 3, 4, 5
• Etanercept had a safety profile similar to that of placebo, with the most commonly occurring adverse effects including injection site reactions, infection, headache, rhinitis, and dizziness 4, 6