Faculty: Paul Yamauchi, MD, PhD
Dr. Yamauchi reviewed the long term use of Enbrel (etanercept) for the treatment of moderate to severe plaque psoriasis. Psoriasis is an immune mediated disease characterized by erythematous scaling plaques and patches. Enbrel is a treatment for patients ages 4 and older who are candidates for systemic therapy or phototherapy for their psoriasis. Severe psoriasis is categorized as more than 10% body surface area involvement. Dosing of Enbrel is based on weight for children (0.8 mg/kg weekly with a maximum dosage of 50 mg weekly). For adults, dosing is 50 mg twice weekly for 3 months followed by a maintenance dose of 50 mg weekly. Enbrel is delivered through subcutaneous injection. It can be delivered through an auto-injectable device. Of note, Enbrel has 25 years of data revealing consistent safety.
Enbrel is a treatment for patients ages 4 and older who are candidates for systemic therapy or phototherapy for their psoriasis.
Dr. Yamauchi recommends screening with a PPD , CBC and for Hepatitis B prior to initiating therapy with etanercept. It is important to note patients who are using Enbrel should not receive live vaccines. If a patient is to receive a live vaccine, this typically requires a break from treatment for a month. According to Dr. Yamauchi, most patients do not have a return of their psoriatic disease during this break time and if they do, their symptoms tend to be minimal. Enbrel is not recommended in patients who have Wegener’s granulomatosis who are receiving cyclophosphamide. It is also contraindicated in patients who use the medication anakinra. The most common adverse reaction to Enbrel is injection site reaction and injection site infection. Studies where patient assessment of etanercept has been reviewed reveal significant improvement of itch and pain (e.g.burning, stinging pain). Serious adverse events to Enbrel are rare and include malignancy, heart failure, myocardial infarction and demyelination.