An Overview of Enbrel (etanercept) (2022)

Enbrel (etanercept) is a biologic drug derived from living cells. It is used to treat rheumatoid arthritis, ankylosing spondylitis, and other types of rheumatic disease that cause pain, stiffness, and inflammation.

Enbrel is classified as a TNF blocker, meaning that it suppresses immune system activity by blocking the activity of a cytokine protein in the body called tumor necrosis factor alpha (TNF-alpha). Excess TNF is closely associated with rheumatic disease.

When TNF is activated, it binds to cell receptors in tissues all over the body and triggers systemic inflammation. Enbrel alleviates rheumatic symptoms by blocking TNF production so that it cannot perform this action.

Although Enbrel is a highly effective medication for many people, it does come with considerable risk. This article covers the uses and benefits of Enbrel along with the risks you should know about before you take it.

An Overview of Enbrel (etanercept) (1)

Uses

Enbrel is approved by the U.S. Food and Drug Administration (FDA) to treat:

  • Rheumatoid arthritis
  • Juvenile idiopathic arthritis
  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Plaque psoriasis (adult and pediatric)

Off-Label Uses

Enbrel may be prescribed off-label for numerous conditions, including:

  • Juvenile forms of arthritis such as of psoriatic arthritis and ankylosing spondylitis
  • Inflammatory conditions such as Behçet's disease and pyoderma gangrenosum
  • Autoimmune conditions such as Crohn's disease

Before Taking

Before you start taking any medication, you should discuss with your healthcare provider your medical and family history, any current conditions you may have, and any drugs or supplements you're taking.

Precautions and Contraindications

Enbrel is not recommended for:

  • People with serious infections when starting the drug
  • People prone to infection due to illnesses that weaken the immune system, such as uncontrolled diabetes

Enbrel may trigger or worsen neurological problems in some people. Healthcare providers use caution when prescribing Enbrel to people with the following nervous system disorders:

  • Multiple sclerosis
  • Transverse myelitis
  • Optic neuritis
  • Guillain-Barre syndromes

Enbrel also isn't recommended for people with moderate to severe alcoholic hepatitis due to an increased risk of death after six months of use.

Pregnancy and Lactation

According to the FDA, there's no statistically significant increase in the risk of birth defects in babies born to women taking Enbrel and no pattern of birth defects associated with it.

(Video) How to Inject Enbrel (etanercept)

A European study comparing outcomes in nine countries found a 5% increase in premature birth when a mother used TNF inhibitors as well as a significant increase in the risk of low birth weight.

A 2015 review of systemic drugs' impact on fertility, pregnancy, and lactation found evidence that Enbrel has no negative impact on fertility in men or women; that it appears to cross the placenta in lower amounts than the TNF inhibitors Humira (adalimumab) and Remicade (infliximab); and that its levels in breast milk appear to be insignificant and not bio-available to healthy, full-term infants.

It's unknown whether it's safe to give live or live-attenuated vaccines to babies exposed to Enbrel in the uterus.

While the risk of birth defects and other problems due to Enbrel appears low, if you are pregnant and considering taking this drug, be sure to discuss your baby's health and the drug's potential impact with your health care team.

Other TNF Inhibitors

Enbrel was the first TNF-inhibiting drug, gaining FDA approval in 1998. Remicade became the second in 1999. Then came Humira in 2002, and Simponi (golimumab) andCimzia (certolizumab pegol) in 2009.

For Enbrel and Remicade, scientists combine human and rodent DNA to produce what are called monoclonal antibodies, which are human-made, cloned antibodies (cells that fight infection.) Humira, Simponi, and Cimzia are made from fully human proteins that produce monoclonal antibodies.

How Are Enbrel, Remicade, and Humira Different?

Dosage

Enbrel is given by injection under the skin, which you (or a friend or family member) can do at home. It's available in pre-filled syringes, an auto-injector pen, or vials that you use to fill syringes.

IndicationDosage
Ankylosing spondylitis (adults)50 milligrams (mg) per week
Juvenile idiopathic arthritis(children)Based on weight; maximum of 50 mg per week
Juvenile plaque psoriasis (children)Based on weight; maximum of 50 mg per week
Plaque psoriasis (adults)50 mg twice a week for 3 months, then stepped down to once weekly
Psoriatic arthritis (adults)50 mg per week
Rheumatoid arthritis (adults)

50 mg per week

Enbrel can be used in combination with methotrexate in patients who do not respond to methotrexate alone. The Enbrel dosage is typically the same regardless of whether it's taken alongside another drug.

How to Take and Store

Enbrel should be stored at a temperature of between 36 and 46 degrees F, but you should allow it to naturally warm up to room temperature before injecting it. (Don't try to heat it fast. Just take it out of the refrigerator and let it sit out.)

(Video) Etanercept Medication Overview

Enbrel can be kept at room temperature for up to 14 days, if needed. It should never be stored in the freezer.

According to the manufacturer, if you're traveling with your medication for more than a few hours, you should wrap Enbrel in bubble wrap and place it in a travel cooler packed withice. Add a thermometer to the cooler and check it every few hours to make sure it's staying in the correct temperature range.

You can obtain a free travel cooler and ice pack for Enbrel by calling the Enbrel Support line at 1-888-4ENBREL. If you're traveling by airplane, check with the airline for their rules and guidelines about transporting temperature-sensitive medication.

Side Effects

All drugs come with a risk of side effects. Not everyone experiences them, but if you do, talk to your healthcare provider about them. Some side effects may go away with continued medication use, but others may be a signal that you need to stop taking the drug.

Common

Common side effects associated with Enbrel include:

  • Injection site reactions
  • Upper respiratory infections, including sinus infections
  • Headaches
  • Dizziness
  • Runny nose
  • Throat irritation

These generally don't require medical attention. If any side effects become severe or persist for a long time, call your healthcare provider.

Severe

Enbrel is associated with some serious adverse reactions, including:

  • New-onset multiple sclerosis or other demyelinating diseases
  • New-onset seizure disorders
  • Myelitis (inflammation of spinal cord)
  • Optic neuritis (inflammation of optic nerve)
  • Pancytopenia (low numbers of red blood cells, white blood cells, and platelets).

Risk of Infections

This drug carries a black box warning, the FDA's most serious type of warning, about the increased risk of serious infections, including tuberculosis. If you develop an infection while taking Enbrel, contact your healthcare provider before taking another dose. You may need to stop taking Enbrel, have special monitoring to ensure the infection doesn't become serious, or both.

Warnings and Interactions

In studies, Enbrel has been associated with a higher incidence of certain serious diseases, including some forms of cancer. These include:

  • Lymphoma
  • Leukemia
  • Skin cancer (both melanoma and non-melanoma)
  • Worsening of and increased risk of death from pre-existing heart disease
  • Pancytopenia (rare)
  • Aplastic anemia (very rare)
  • Hepatitis B reactivation
  • New-onset autoimmune disease

An allergic reaction is possible with Enbrel. If you have symptoms including throat closure and difficulty breathing (anaphylactic shock), get emergency medical help immediately.

If you have a latex allergy, be sure to alert your healthcare provider and pharmacist, as components of needles or autoinjectors may contain natural rubber, which is derived from latex.

Immunizations

You shouldn't get live vaccines while taking Enbrel. If your child has been prescribed this drug, you should bring them up-to-date on vaccinations before they start it, if possible. Be sure you discuss this with your pediatrician.

Drug Interactions

Enbrel may interact negatively with certain medications. This drug should not be combined with other immunosuppressive biologic drugs aside from azulfidine (sulfasalazine), which is one exception to this guideline.

(Video) Etanercept Treats Various Inflammatory Conditions - Overview

Make sure your healthcare provider knows all of the drugs you're taking, including over-the-counter medications and dietary supplements, so they can watch for any potential problems. Your pharmacist is also a valuable resource for ensuring your mix of treatments is safe.

When Should You Change Your TNF Blocker?

Summary

A Word From Verywell

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Food and Drug Administration. Enbrel (etanercept) label.

  2. Tirado-Sánchezab A, de la Fuente-Garcíaa V, Ponce-Oliveraa RM. Off-label uses of etanercept in dermatology. Rev Méd del Hospital Gen de Méx. 2016 Mar;79(1):26-32. doi:10.1016/j.hgmx.2015.10.005

  3. Starting Enbrel. What to expect.

  4. Weber-Schoendorfer C, Oppermann M, Wacker E, et al. Pregnancy outcome after TNF-α inhibitor therapy during the first trimester: a prospective multicentre cohort study.Br J Clin Pharmacol. 2015 Mar;80(4):727-739. doi:10.1111/bcp.12642

  5. Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation.J Dtsch Dermatol Ges. 2015;13(4):277-290. doi:10.1111/ddg.12596

  6. U.S. Food and Drug Administration. Information on tumor necrosis factor (TNF) blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi).

Additional Reading

(Video) Etanercept (Enbrel)

(Video) Etanercept

FAQs

Is Enbrel a high risk medication? ›

Serious infections: Enbrel may weaken your immune system. People being treated with Enbrel have a higher risk of developing serious infections including fungal, bacterial, viral, and tuberculosis infections. In some cases, these infections can lead to hospitalization or even death.

What drugs should not be taken with Enbrel? ›

Some products that may interact with this drug include: abatacept, interleukin-1 blockers (such as anakinra, canakinumab, rilonacept), live vaccines (such as measles, mumps, polio, rubella, typhoid, varicella, yellow fever), other medications for autoimmune disease (such as azathioprine, cyclophosphamide).

How long does it take Enbrel to start working? ›

Some people with moderate to severe rheumatoid arthritis taking ENBREL start to feel less pain, stiffness, and swelling after just 2 weeks. Most people finding relief saw results within 3 months, and some saw further improvements at 6 months.

What is Enbrel etanercept used for? ›

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderately to severely active rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.

What is the most commonly reported side effect of Enbrel? ›

Injection-site reactions is one of the most commonly reported side effects of Enbrel. These may include: redness or discoloration. itching.

What are the negative side effects of Enbrel? ›

What Are Side Effects of Enbrel?
  • Mild nausea.
  • Vomiting.
  • Diarrhea.
  • Stomach pain.
  • Headache.
  • Redness or discomfort at the injection site.
  • Heartburn.
  • Weight changes.

Can Enbrel cause hair loss? ›

Biologics: In rare cases, biologics such as etanercept (Enbrel) or adalimumab (Humira) have hair loss side effects. It's not known exactly why these drugs affect hair growth, but it's suspected it's because they change the balance of messenger molecules known as “cytokines” in the body.

Can Enbrel cause blood clots? ›

Increased susceptibility to infection. Weakened bones (osteopenia, osteoporosis) Blood clots, venous thromboembolism.

Does Enbrel help with fatigue? ›

Other medications, such as etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) have been reported to reduce fatigue, but some experts suspect this reduction may be limited and not permanent.

Where is the best place to inject Enbrel? ›

You can inject ENBREL on the front of the middle thigh, on the outer area of your upper arm (outer arm only if someone else is giving you the injection), or on your stomach (except for the 2-inch area around your belly button). Choose a different site each time you give yourself an injection.

How long does Enbrel stay in your body? ›

In healthy adults, it takes about three to four weeks after the last injection of etanercept, on average, for most of the medication to be gone from the body.

Is Enbrel safe long term? ›

"The current data in Rheumatoid Arthritis suggest that Enbrel is both effective and safe in long-term use," said Mark Genovese, M.D., Stanford University Medical Center, Palo Alto, California.

Does Enbrel cause liver damage? ›

Etanercept has been linked to rare instances of acute, clinically apparent liver injury.

Can Enbrel cause kidney damage? ›

Renal side effects including pyelonephritis have been reported. At least one case of necrotizing crescentic glomerulonephritis has been reported, in addition to a case of proliferative lupus nephritis.

What diseases does Enbrel treat? ›

What Conditions does ENBREL Treat?
  • psoriasis associated with arthritis.
  • moderate to severe plaque psoriasis.
  • rheumatoid arthritis.
  • polyarticular juvenile idiopathic arthritis.
  • ankylosing spondylitis, a rheumatic disease causing pain and stiffness in backbone.
  • non-radiographic axial spondyloarthritis.

Does Enbrel cause brain fog? ›

One way to combat brain fog is by taking medicine for RA. Biologic drugs, called TNF inhibitors, block inflammation. These drugs include etanercept (Enbrel) and adalimumab (Humira). These drugs may also improve or prevent brain fog.

What happens when you stop Enbrel? ›

No, stopping Enbrel won't cause side effects. However, symptoms of your condition may return or worsen when you stop taking the drug. For this reason, do not stop taking Enbrel without talking with your doctor first.

Does Enbrel weaken your immune system? ›

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body.

Is Enbrel better than methotrexate? ›

ENBREL monotherapy has greater efficacy compared with methotrexate as monotherapy across key measures of psoriatic arthritis activity.

Can etanercept cause high blood pressure? ›

The incidence of hypertension ranged from 0% to 13%, and the highest incidence occurred in the trials of patients treated with etanercept during a 2-year period.

Does Enbrel cause neuropathy? ›

According to the findings, there was more than two and a half times the risk of peripheral neuropathy for past users of drugs like Humira and Enbrel. There was only a small 14% increased risk among new users of the drugs, however.

What is the safest biologic for rheumatoid arthritis? ›

The available evidence indicates that Orencia and Kineret have the lowest risk of serious side effects. However, Kineret, which is given as an injection under the skin every day, causes more redness, itching, rash, and pain at the injection site than the other biologics that are given in this way.

How Much Does Enbrel cost per month? ›

Enbrel is a very high-priced medication with an average retail price of $8,000 per month. Paying for Enbrel without insurance coverage is daunting, but it can be done using a variety of cost-saving strategies.

What should I check before giving etanercept? ›

Before starting etanercept, you'll have a chest x-ray and tests to check if you've ever been exposed to tuberculosis (TB). If you have, you may need treatment for TB before you can start taking it.

What is Stage 4 rheumatoid arthritis? ›

At stage 4, there's no longer inflammation in the joint. This is end-stage RA, when joints no longer work. In end-stage RA, people may still experience pain, swelling, stiffness, and mobility loss. There may be reduced muscle strength.

Will Enbrel help osteoarthritis? ›

LONDON — Subcutaneous etanercept (Enbrel, Immunex Corp), a tumor necrosis factor (TNF) inhibitor, improves pain and structural damage in patients with osteoarthritis of the hand, provided they are symptomatic, have clear signs of inflammation, and are in a pre-erosive or erosive state, a proof-of-concept study ...

What does autoimmune fatigue feel like? ›

The fatigue from an autoimmune disease differs from the tiredness most people feel after long periods of work or exercise or when they haven't slept well. It's a feeling of exhaustion all the time that interferes with the ability to function.

How can I make Enbrel less painful? ›

Numbing the area with ice before and after administration may also help reduce stinging. Injecting into the stomach area is generally less painful than injecting into the thigh. Make sure you rotate injection sites to reduce scar tissue build up.

What is the cost of Enbrel injections? ›

Enbrel
QuantityDoseAverage cash price (2021)
1 carton of 4 mini cartridges50 mg$9,513
1 carton of 4 SureClick injectors50 mg$8,939
1 carton of 4 syringes50 mg$8,898
Oct 27, 2021

Does Enbrel come in a pill form? ›

Enbrel is available in the following forms: liquid solution inside single-dose prefilled syringes* liquid solution inside prefilled SureClick auto-injectors* liquid solution inside Enbrel Mini single-dose prefilled cartridges* (used with AutoTouch auto-injectors)

How do I know if my Enbrel is working? ›

by Drugs.com

Enbrel starts to have some effect within one to two weeks, although it may take 3 to 6 months for the full effects to develop. Effects of Enbrel include less pain, stiffness, and swelling, and improvements in movement and laboratory markers of inflammation.

What happens to Enbrel if not refrigerated? ›

Enbrel may be left unrefrigerated for up to 14 days, as long as it is protected from light and not exposed to heat. Once Enbrel has been taken out of the refrigerator for more than 15 minutes, do not put it back in the refrigerator.

Does Enbrel raise blood sugar? ›

Diabetes: Etanercept may cause a decrease in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

Who should take Enbrel? ›

ENBREL can be used with or without methotrexate. ENBREL is indicated for chronic moderate to severe plaque psoriasis (PsO) in children 4 years and older and adults who may benefit from taking injections or pills (systemic therapy) or phototherapy (ultraviolet light).

How well does Enbrel work? ›

Enbrel has an average rating of 7.8 out of 10 from a total of 262 ratings on Drugs.com. 73% of reviewers reported a positive experience, while 13% reported a negative experience.
...
User Reviews for Enbrel.
ConditionPsoriatic Arthritis
Avg. Rating7.8
Reviews51 reviews
Compare78 medications
6 more columns

What class of drug is Enbrel? ›

Etanercept is commonly known as Enbrel. It is a biologic drug that is in a class of drugs called anti-TNFs or TNF blockers.

Is Enbrel safe long term? ›

"The current data in Rheumatoid Arthritis suggest that Enbrel is both effective and safe in long-term use," said Mark Genovese, M.D., Stanford University Medical Center, Palo Alto, California.

Which is better Humira or Enbrel? ›

Enbrel and Humira are very similar drugs. They're equally effective at relieving the symptoms of RA. However, there are slight differences, some of which might make one more convenient for you to use. For instance, Humira can be taken every other week or weekly, while Enbrel can only be taken weekly.

Is Enbrel better than methotrexate? ›

ENBREL monotherapy has greater efficacy compared with methotrexate as monotherapy across key measures of psoriatic arthritis activity.

Does Enbrel affect your liver? ›

Etanercept has been linked to rare instances of acute, clinically apparent liver injury.

Does Enbrel raise blood sugar? ›

Diabetes: Etanercept may cause a decrease in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

Can Enbrel cause kidney damage? ›

Renal side effects including pyelonephritis have been reported. At least one case of necrotizing crescentic glomerulonephritis has been reported, in addition to a case of proliferative lupus nephritis.

Can Enbrel cause blood clots? ›

Increased susceptibility to infection. Weakened bones (osteopenia, osteoporosis) Blood clots, venous thromboembolism.

What happens when you stop Enbrel? ›

No, stopping Enbrel won't cause side effects. However, symptoms of your condition may return or worsen when you stop taking the drug. For this reason, do not stop taking Enbrel without talking with your doctor first.

Does Enbrel cause hair loss? ›

Biologics: In rare cases, biologics such as etanercept (Enbrel) or adalimumab (Humira) have hair loss side effects. It's not known exactly why these drugs affect hair growth, but it's suspected it's because they change the balance of messenger molecules known as “cytokines” in the body.

Is there an alternative to Enbrel? ›

If you're paying out of pocket, Enbrel will cost you less than another popular arthritis drug, Humira, but more than several other TNF blockers — Avsola, Remicade, Inflectra, Renflexis, Cimzia, and Simponi.

How long does Enbrel stay in your system? ›

In healthy adults, it takes about three to four weeks after the last injection of etanercept, on average, for most of the medication to be gone from the body.

Which is the safest biologic for RA? ›

The available evidence indicates that Orencia and Kineret have the lowest risk of serious side effects. However, Kineret, which is given as an injection under the skin every day, causes more redness, itching, rash, and pain at the injection site than the other biologics that are given in this way.

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