Etanercept for juvenile rheumatoid arthritis

Examples

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Brand Name	Generic Name
Enbrel	etanercept

How It Works

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Rheumatoid arthritis inflammation is caused in part by a substance called tumor necrosis factor (TNF) in the joint area. Etanercept is a genetically engineered protein that slows or stops rheumatoid arthritis inflammation and joint damage by blocking the action of TNF.¹

Why It Is Used

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Etanercept is used to treat moderate to severe rheumatoid arthritis symptoms and to prevent joint damage, particularly in people who have had side effects or poor results from methotrexate treatment.

Etanercept is usually used after nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and methotrexate have been tried. Sometimes it is used at the same time as these other medicines. It is used to treat polyarticular JRA. Sometimes it is used to treat pauciarticular JRA that has extended to more joints and is being treated like polyarticular JRA.²

Etanercept has shown positive preliminary results as a treatment for JRA-related inflammatory eye disease.³

How Well It Works

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Etanercept:

• Improves joint pain and swelling as soon as 2 weeks from the beginning of treatment.⁴
• In a preliminary study, etanercept improved symptoms in 80% of children with polyarticular JRA (polyarthritis). This improvement was maintained for 2 years after treatment began.⁵ In another study of children with severe, long-standing polyarticular JRA who have not been helped by methotrexate, etanercept provided symptom improvement that was sustained for at least 2 years (the period of the study).⁶
• Has shown promising results in safely improving vision in a small sample of children with JRA-related inflammatory eye disease (uveitis).³
• May not be an effective treatment for a child with systemic JRA.⁴
• Is not usually recommended for treating pauciarticular JRA.

Side Effects

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The most common side effect of TNF antagonists, such as etanercept, is an allergic reaction to the injection (shot). If you have a reaction to the shot, it will happen right away, either during the shot or within 1 to 2 hours after the shot. Your doctor may give you medicines to prevent or stop the reaction.

Symptoms of a reaction to the shot include:

• Fever.
• Chills.
• Chest pain.
• Shortness of breath.
• Itching (pruritus).
• Headache.
• Nausea.
• Heat and redness (flushing) in the face.
• Rash.
• Fatigue.
• Dizziness.

Warnings about serious side effects of TNF antagonists have been issued. The U.S. Food and Drug Administration (FDA) and the drug’s manufacturers have warned about:

• An increased risk of a serious infection. TNF antagonists affect your body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
• An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
• A possible increased risk of developing lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk. There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking TNF antagonists, that often results in death.
• An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have a fever and dark brown urine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Etanercept treatment is very expensive.

Further study is needed to determine whether etanercept has any dangerous long-term effects.

Etanercept is not used to treat people with lupus or multiple sclerosis, based on rare reports of etanercept making these diseases worse.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Bathon JM, et al. (2000). A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. New England Journal of Medicine, 343(22): 1586–1593.

2. Weiss JR, Ilowite NT (2005). Juvenile idiopathic arthritis. Pediatric Clinics of North America, 52(2): 413–442.

3. Reiff A, et al. (2001). Etanercept therapy in children with treatment-resistant uveitis. Arthritis and Rheumatism, 44(6): 1411–1415.

4. Wargula JC, Lovell DJ (2000). Use of etanercept in children. Bulletin on the Rheumatic Diseases, 49(12): 1–4.

5. Culy CR, Keating GM (2003). Spotlight on etanercept in rheumatoid arthritis, psoriatic arthritis, and juvenile rheumatoid arthritis. Biodrugs, 17(2): 139–145.

6. Lovell DJ, et al. (2003). Long-term efficacy and safety of etanercept in children with polyarticular-course juvenile rheumatoid arthritis. Arthritis and Rheumatism, 48(1): 218–226.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	June 25, 2008