Enbrel (Etanercept) Dosing and Usage for Autoimmune Diseases
For adult plaque psoriasis, start Enbrel at 50 mg subcutaneously twice weekly for 12 consecutive weeks, then reduce to 50 mg once weekly for maintenance. 1, 2
Dosing by Indication
Adult Plaque Psoriasis
- Induction phase: 50 mg subcutaneously twice weekly for 12 weeks 1, 2
- Maintenance phase: 50 mg once weekly after initial 12 weeks 1, 2
- Higher maintenance dosing: 50 mg twice weekly may be continued beyond 12 weeks if better disease control is needed 1
- Expected efficacy: 49% of patients achieve PASI-75 (75% improvement) at 12 weeks, increasing to 59% at 24 weeks with the higher dose 1
Rheumatoid Arthritis and Psoriatic Arthritis
- Standard dose: 50 mg once weekly, with or without methotrexate 2
- This simpler once-weekly regimen differs from the psoriasis induction protocol 2
Ankylosing Spondylitis
- Standard dose: 50 mg once weekly 2
Pediatric Patients (≥4 years old)
- Weight-based dosing: 0.8 mg/kg weekly, maximum 50 mg per week 2
- Approved for juvenile idiopathic arthritis and pediatric plaque psoriasis 2
Site-Specific Psoriasis Treatment
Enbrel is highly effective for difficult-to-treat psoriasis locations:
- Scalp psoriasis: 86.8% improvement in PSSI score at 12 weeks versus 20.4% with placebo 1, 3
- Nail psoriasis: 41.7% improvement in NAPSI score at 12 weeks 1, 3
- Pustular or erythrodermic psoriasis: Can be used but with moderate strength recommendation 1
Combination Therapy Options
When monotherapy provides inadequate clearing, combine Enbrel with:
Topical Agents (Strongest Evidence)
- High-potency corticosteroids with or without vitamin D analogues 1, 3
- This combination has Grade A recommendation strength 1
Systemic Agents
- Methotrexate: Grade B recommendation for augmented efficacy 1, 3
- Acitretin: Grade B recommendation; may also reduce squamous cell carcinoma risk in susceptible patients 1
- Apremilast: Grade C recommendation (weaker evidence) 1
- Cyclosporine: Grade C recommendation, use only when clinically indicated 1
Phototherapy
- Narrowband UVB: Grade B recommendation; one study showed 84.9% achieved PASI-75 when combining etanercept 50 mg twice weekly with NB-UVB three times weekly 1
- Long-term safety of this combination is not well established 1
Patient Selection Criteria
Use Enbrel in patients who meet these criteria:
- Moderate-to-severe plaque psoriasis (PASI ≥10 and DLQI >10) 1
- AND at least one of the following:
Administration Details
- Route: Self-administered subcutaneous injection 1, 2
- Formulation: Available as pre-filled syringes or auto-injectors 2
- The subcutaneous route provides convenience compared to intravenous biologics like infliximab 1
Baseline Screening Requirements
Before initiating Enbrel, obtain:
- Tuberculosis screening with PPD test or interferon-gamma release assay 3, 4
- Complete blood count 3, 4
- Liver function tests 3, 4
- Hepatitis B and C screening 3, 5
Safety Considerations and Contraindications
Avoid Enbrel in patients with:
- Active tuberculosis or untreated latent tuberculosis 3, 6
- Demyelinating diseases 5, 6
- Heart failure (TNF-α inhibitors should be avoided) 5
- Active serious infections 3
Common adverse effects:
Important warnings:
- Avoid live vaccines while on treatment 3
- Monitor for signs of infection throughout therapy 3
- Risk of reactivation of hepatitis B in carriers 3
Clinical Pearls
- Etanercept has a more favorable safety profile compared to some other TNF inhibitors, with lower rates of infusion reactions since it's subcutaneous 1, 8
- Response typically begins within 2-4 weeks, with maximum benefit by week 12 1, 9
- Efficacy is sustained with long-term use (up to 9 years documented) 8, 10
- Unlike infliximab, etanercept forms less stable complexes with membrane-bound TNF, which may explain some differences in clinical response patterns 1
- The twice-weekly dosing during induction is critical for optimal response rates in psoriasis 1, 9