Abstract
Etanercept (Enbrel®2) is a subcutaneously administered biological response modifier that binds and inactivates tumour necrosis factor-α, a proinflammatory cytokine.
In patients with early active rheumatoid arthritis, etanercept 25mg twice weekly was associated with a more rapid improvement in disease activity and a significantly greater cumulative response than methotrexate over 12 months of treatment in a randomised, double-blind trial. In addition, etanercept recipients showed a slower rate of radiographic progression and a more rapid improvement in quality of life than methotrexate recipients. The efficacy of etanercept was maintained at 3 years’ follow-up.
Etanercept was also significantly better than placebo at reducing disease activity in patients who had an inadequate response to previous treatment with disease-modifying antirheumatic drugs (DMARDs) in several well controlled trials. At study end (after 3 or 6 months’ treatment), the percentage of patients achieving an American College of Rheumatology 20% (ACR20) response with etanercept (25mg or 16 mg/m2 twice weekly) was 59–75% as monotherapy and 71 % in combination with methotrexate; corresponding placebo response rates were 11–14% and 27%, respectively. Response has been maintained in patients who continued treatment for up to 5 years.
In patients with psoriatic arthritis, etanercept 25mg twice weekly significantly reduced disease activity and improved skin lesions in two double-blind, placebo-controlled, 12- to 24-week trials. In the 24-week study, ACR20 response rates (50 vs 13%), psoriatic arthritis response rates (70 vs 23%) and the median improvement in skin lesions (33 vs 0%) were significantly greater in etanercept than in placebo recipients.
In patients with polyarticular-course juvenile rheumatoid arthritis, etanercept resulted in improvements in all measures of disease activity and was significantly more effective than placebo at reducing disease flare. Eighty percent of patients receiving etanercept achieved a ≥30% reduction in disease activity over 7 months of treatment, and this was maintained for up to 2 years in a trial extension.
Etanercept was generally well tolerated in children and adults in clinical trials; the most commonly occurring adverse effects included injection site reactions, infection, headache, rhinitis and dizziness.
In conclusion, etanercept has emerged as an important new treatment option in inflammatory arthritis. Etanercept provides rapid and sustained improvements in disease activity in patients with early and DMARD-refractory rheumatoid arthritis and has been shown to inhibit radiographic progression in those with early disease. Well controlled studies have also demonstrated the efficacy of etanercept in patients with psoriatic arthritis or polyarticular-course juvenile rheumatoid arthritis.
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References
Jarvis B, Faulds D. Etanercept: a review of its use in rheumatoid arthritis. Drugs 1999 Jun; 57(6): 945–66
Davis T, Friend D, Smith CA. Comparative TNF binding characteristics of etanercept (Enbrel®) and infliximab (Remicade) [abstract no. FRI0081 and poster]. Ann Rheum Dis 2002; 61Suppl. 1: 184
Wooley PH, Dutcher J, Widmer MB, et al. Influence of a recombinant human soluble tumor necrosis factorreceptor FC fusion protein on type II collagen-induced arthritis in mice. J Immunol 1993 Dec 1; 151(11): 6602–7
Drynda S, Kühne C, Kekow J. Soluble tumour necrosis factor receptor treatment does not affect raised transforming growth factor β levels in rheumatoid arthritis. Ann Rheum Dis 2002 Mar; 61(3): 254–6
Catrina AI, Lampa J, Ernestam S, et al. Anti-tumour necrosis factor (TNF)-α therapy (etanercept) down-regulates serum matrix metalloproteinase (MMP)-3 and MMP-1 in rheumatoid arthritis. Rheumatology (Oxford) 2002 May; 41(5): 484–9
Verschueren PC, Markusse H, Smeets TJM, et al. Reduced cellularity and expression of adhesion molecules and cytokines after treatment with soluble human recombinant TNF receptor (P75) in RA patients [abstract no. 762]. Arthritis Rheum 1999 Sep; 42(9 Suppl.): S197
Schotte H, Willeke P, Schorat MA, et al. Longterm treatment with etanercept significantly reduces the number of TNFα and IL-1 producing peripheral blood mononuclear cells from patients with rheumatoid arthritis [abstract no. 375]. Arthritis Rheum 2001 Sep; 44(9 Suppl.): S115
Lampa J, Berg L, Rogberg S, et al. Functional effects on peripheral T-cells of treatment with soluble TNF-α receptors in rheumatoid arthritis [abstract no. POS-417]. Ann Rheum Dis 2000 Jul; 59Suppl. 1: 163
Moreland LW, Bucy RP, Weinblatt ME, et al. Immune function in patients with rheumatoid arthritis treated with etanercept. Clin Immunol 2002 Apr; 103(1): 13–21
Immunex. Enbrel® (etanercept) prescribing information [online]. Available from URL: http://www.immunex.com [Accessed 2002 Sep 13]
Lebsack ME, Hanna RK, Lange MA, et al. Absolute bioavailability of TNF receptor fusion protein following subcutaneous injection in healthy volunteers [abstract no. 233]. Pharmacotherapy 1997; 17(5): 1118
European Agency for Evaluation of Medicinal Products. Scientific discussion: Enbrel® [online]. Available from URL: http://www.emea.eu.int [Accessed 2002 Mar 10
European Agency for Evaluation of Medical Products. Enbrel®: summary of product characteristics [online]. Available from URL: http://emea.eu.int [Accessed 2002 Mar 10
Soran O, Feldman AM, Schneider VM, et al. The pharmacokinetics of etanercept in patients with heart failure [letter]. Br J Clin Pharmacol 2001 Feb; 51: 191–2
Korth-Bradley JM, Parks V, Buckwalter ME, et al. Lack of a clinically relevant interaction between etanercept (E) and warfarin (W) [poster]. American College of Clinical Pharmacy Spring Practice and Research Forum; 2002 Apr 7–10; Savannah (GA)
Patat AA, Parks V, Simcoe DK, et al. Lack of a clinically relevant interaction between etanercept (E) and digoxin (D) [abstract no. 82 and poster]. Clin Pharmacol Ther 2002; 71: P64
Bathon JM, Martin RW, Fleischmann RM, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 2000 Nov; 343(22): 1586–93
Genovese MC, Bathon JM, Martin RW, et al. Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum 2002 Jun; 46(6): 1443–50
Genovese M, Martin R, Fleischmann R, et al. Etanercept (Enbrel®) in early erosive rheumatoid arthritis (ERA trial): observations at 3 years [abstract no. 151]. Arthritis Rheum 2001 Sep; 44(9 Suppl.): 78
Kosinski M, Kujawski SC, Martin R, et al. Health-related quality of life in early rheumatoid arthritis: impact of disease and treatment response. Am J Manag Care 2002 Mar; 8(3): 231–40
Moreland LW, Baumgartner SW, Schiff MH, et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein. N Engl J Med 1997 Jul 17; 337(3): 141–7
Moreland LW, Schiff MH, Baumgartner SW, et al. Etanercept therapy in rheumatoid arthritis: arandomized, controlled trial. Ann Intern Med 1999 Mar 16; 130(6): 478–86
Wajdula J, on behalf of the Etanercept European Investigators Network. A doubleblind, placebo-controlled study of the efficacy and safety of four different doses of etanercept in patients with rheumatoid arthritis [abstract no. POS-414]. Ann Rheum Dis 2000 Jul; 59 Suppl. 1: S163
Weinblatt ME, Kremer JM, Bankhurst AD, et al. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 1999 Jan 28; 340(4): 253–9
Moreland LW, Cohen SB, Baumgartner SW, et al. Long-term safety and efficacy of etanercept in patients with rheumatoid arthritis. J Rheumatol 2001 Jun; 28: 1238–44
Baumgartner SW, Moreland LW, Cohen SB, et al. Long-term use of Enbrel® (etanercept) in patients with DMARD-refractory rheumatoid arthritis [abstract no. W114]. J Rheumatol 2001 Jul; 28 Suppl. 63: 104
Willis RF, Pedersen R, Etanercept European Investigators Network. A long-term, open-label trial of the safety and efficacy of etanercept (25 mg twice weekly) in patients with rheumatoid arthritis (interim analysis) [abstract no. W104]. J Rheumatol 2001 Jul; 28 Suppl. 63: 101
Klareskog L, Wajdula J, Pedersen R, et al. A long-term, open-label trial of the safety and efficacy of etanercept (25mg twice weekly) in patients with rheumatoid arthritis (interim analysis) [abstract no. FRI0050]. Ann Rheum Dis 2002; 61 Suppl. 1: 175
Moreland LW, Cohen S, Fleischmann RM, et al. Safety and efficacy of up to 5 years of etanercept (Enbrel®) therapy in rheumatoid arthritis [abstract no. FRI0078]. Ann Rheum Dis 2002; 61 Suppl. 1: 183
Weinblatt ME, Kremer JM, Lange M, et al. Long-term safety and efficacy of combination therapy with methotrexate and etanercept (Enbrel®) [abstract no. 1982]. Arthritis Rheum 1999 Sep; 42(9 Suppl.): 401
Kremer JM, Weinblatt ME, Fleischmann RM, et al. Etanercept (Enbrel®) in addition to methotrexate in rheumatoid arthritis: long-term observations [abstract no. 152]. Arthritis Rheum 2001 Sep; 44(9 Suppl.): 78
Kremer JM, Weinblatt ME, Fleischmann RM, et al. Etanercept (Enbrel®) in addition to methotrexate in rheumatoid arthritis: long-term observations [abstract no. FRI0070]. Ann Rheum Dis 2002; 61 Suppl. 1: 181
Yazici Y, Erkan D, Kulman I, et al. Decreased flares of rheumatoid arthritis during the first year of etanercept treatment: further evidence of clinical effectiveness in the ‘real world’. Ann Rheum Dis 2002 Jul; 61(7): 638–40
Geborek P, Crnkic M, Petersson IF, et al. Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden. Ann Rheum Dis 2002 Sep; 61(9): 793–8
Gaebel K, Levine M, Wang E. Monitoring of health outcomes in patients using etanercept (Enbrel®) in a community setting: the Enbrel Community Health Outcomes [ECHO] Study) [abstract no. SAT0347]. Ann Rheum Dis 2002; 61 Suppl. 1: 348
Van Vollenhoven RF, Ernestam S, Harju A, et al. Etanercept plus MTX versus etanercept in the Stockholm TNF-alpha antagonist registry (STURE): the combination is more effective at 3 to 12 months follow-up [abstract no. FRI0112]. Ann Rheum Dis 2002; 61 Suppl. 1:193
Power DJ, Yocum DE, Nordensson KA. Assessment of biologic agents use in a university rheumatology clinic [abstract no. AB0124]. Ann Rheum Dis 2002; 61 Suppl. 1: 380
Feltelius NJV, Lindblad S, Fored M, et al. A national drug monitoring system — TNF blocker treatment in patients with rheumatoid arthritis [abstract no. FRI0044]. Ann Rheum Dis 2002; 61 Suppl. 1: 173
Mease PJ, Goffe BS, Metz J, et al. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet 2000 Jul 29; 356: 385–90
Lebwohl M, Gottlieb A, Mease P, et al. Etanercept improves psoriasis activity in patients with psoriatic arthritis: results of a phase 3 multicentre clinical trial [abstract P561 and poster]. 60th Annual Scientific Meeting of the American Academy of Dermatology; 2002 Feb 22–27; New Orleans (LA)
Wanke LA, Gottleib AB, Burge DJ, et al. Etanercept improves health-related quality of life in patients with psoriatic arthritis [abstract no. PS31 and poster]. 60th Annual Meeting of the American Academy of Dermatology; 2002 Feb 22–27; New Orleans (LA)
Lovell DJ, Giannini EH, Reiff A, et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. N Engl J Med 2000 Mar 16; 342(11): 763–9
Lovell DJ, Giannini EH, Passo M, et al. Long-term efficacy of etanercept (Enbrel®) in children with polyarticular-course juvenile rheumatoid arthritis [poster]. VII European Pediatric Rheumatology Congress; 2001 Sep; Berlin
Lahdenne P, Honkanen V. Infliximab vs. etanercept in the treatment of severe juvenile chronic arthritis [abstract no. 1888]. Arthritis Rheum 2000 Sep; 43(9 Suppl.): 381
Kietz DA, Pepmueller PH, Moore TL. Therapeutic use of etanercept in polyarticular course juvenile idiopathic arthritis over a two year period. Ann Rheum Dis 2002 Feb; 61(2): 171–3
Choi HK, Seeger JD, Kuntz KM. A cost effectiveness analysis of treatment options for methotrexate-naive rheumatoid arthritis. J Rheumatol 2002 Jun; 29(6): 1156–65
Choi HK, Seeger JD, Kuntz KM. A cost-effectiveness analysis of treatment options for patients with methotrexate-resistant rheumatoid arthritis. Arthritis Rheum 2000 Oct; 43(10): 2316–27
Brennan A, Bansback N, Conway P, et al. Modelling the cost-effectiveness of etanercept in adults with rheumatoid arthritis (RA) in the UK [abstract no. 630]. Arthritis Rheum 2001 Sep; 44(9 Suppl.): S157
Jobanputra P, Barton P, Bryan S, et al. The clinical effectiveness and cost-effectiveness of new drug treatments for rheumatoid arthritis: etanercept and infliximab [online]. Available from URL: http://www.nice.org.uk/pdf/RAAssessmentReport.pdf [Accessed 2002 Sep 23]
Malone DC, Ortmeier BG. Cost efficacy of etanercept versus infliximab plus methotrexate in the treatment of DMARD-resistant rheumatoid arthritis [abstract no. SAT0320]. Ann Rheum Dis 2002; 61 Suppl. 1: 340
Malone DC. Cost-effectiveness analysis of etanercept monotherapy versus infliximab plus methotrexate in the treatment of rheumatoid arthritis [abstract no. 1617]. Arthritis Rheum 2001 Sep; 44(9 Suppl.): S322
Nuijten MJC, Engelfriet P, Duijn K, et al. A cost-cost study comparing etanercept with infliximab in rheumatoid arthritis. Pharmacoeconomics 2001; 19(10): 1051–64 au]53._Geborek P, Eberhardt K, Saxane T. Etanercept and infliximab treatment reduces hospital care in arthritis patients [abstract no. FRI0109]. Annual European Congress on Rheumatology; 2002 Jun 12–15; Stockholm
Geborek P, Eberhardt K, Saxane T. Etanercept and infliximab treatment reduces hospital care in arthritis patients [abstract no. FRI0109]. Annual European Congress on Rheumatology; 2002 Jun 12–15; Stockholm
Geborek P, Eberhardt K, Larsson B, et al. Etanercept and infliximab treatment improves working capacity in arthritis patients [abstract no. FRI0038]. Annual European Congress on Rheumatology; 2002 Jun 12–15; Stockholm
Wajdula J, Pedersen R, Sanda M, et al. A long-term, open-label trial of the safety and efficacy of etanercept (25 mg twice weekly) in patients with rheumatoid arthritis (interim analysis) [abstract no. 974]. Arthritis Rheum 2000 Sep; 43 Suppl.: 229
Klareskog L, Moreland LM, Bohen SB, et al. Global safety and efficacy of up to five years of etanercept (Enbrel®) therapy [abstract no. 150]. Arthritis Rheum 2001 Sep; 44(9 Suppl.): S77
Sabath DF, Holman J, Wallis WJ. Serious infection reports with etanercept (Enbrel®) therapy [abstract no. OP0099]. Ann Rheum Dis 2002; 61(Suppl. 1): 38
Holman J, Wallis WJ, Sabath DF, et al. Tuberculosis reports with etanercept (Enbrel®) therapy [abstract no. FRI0024]. Ann Rheum Dis 2002; 61 Suppl. 1: 167
Shakoor N, Michalska M, Harris CA, et al. Drug-induced systemic lupus erythe-matosus associated with etanercept therapy. Lancet 2002 Feb 16; 359(9306): 579–80
Bleumink GS, ter Borg EJ, Ramselaar CG, et al. Etanercept-induced subacute cutaneous lupus erythematosus [letter]. Rheumatology (Oxford) 2001 Nov; 40(11): 1317–9
Brion PH, Mittal-Henkle A, Kalunian KC. Autoimmune skin rashes associated with etanercept for rheumatoid arthritis [letter]. Ann Intern Med 1999 Oct 19; 131(8): 634
Galaria NA, Werth VP, Schumacher HR. Leukocytoclastic vasculitis due to etanercept. J Rheumatol 2000; 27(8): 2041–4
Mohan N, Edwards ET, Cupps TR, et al. Demyelination occurring during anti-tumor necrosis factor α therapy for inflammatory arthritides. Arthritis Rheum 2001 Dec; 44(12): 2862–9
Sicotte NL, Voskuhl RR. Onset of multiple sclerosis associated with anti-TNF therapy. Neurology 2001 Nov 27; 57(10): 1885–8
Acknowledgments
The full text article in Drugs 2002; 62 (17): 2493–2537 was reviewed by: A. Eigler, Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; R. Fleischmann, Radiant Research-Dallas, Dallas, Texas, USA; G. Jones, Department of Rheumatology, Menzies Centre for Population Health Research, Hobart, Australia; D. Lovell, Pediatric Rheumatology, Children’s Hosptial Medical Center, Cincinnati, Ohio, USA; N.J. McGriff-Lee, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Phildaelphia, Pennsylvania, USA; L.W. Moreland, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA; D.L. Scott, Department of Rheumatology, King’s Healthcare (Dulwich), London, England; W. Taylor, Department of Medicine, Wellington School of Medicine, Wellington, New Zealand.
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This Spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in full in Drugs 2002; 62 (17): 2493–2537
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Culy, C.R., Keating, G.M. Spotlight on Etanercept in Rheumatoid Arthritis, Psoriatic Arthritis and Juvenile Rheumatoid Arthritis. BioDrugs 17, 139–145 (2003). https://doi.org/10.2165/00063030-200317020-00006
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DOI: https://doi.org/10.2165/00063030-200317020-00006