Etanercept (Enbrel)

Important information about etanercept:

Etanercept, also known by the brand name Enbrel®, is used to treat inflammatory diseases such as juvenile arthritis. Etanercept works by interfering with the activity of a protein called tumor necrosis factor. It reduces inflammation in the body. Etanercept may be taken alone or with another disease-modifying drug (DMARD). Learn more about etanercept.

It may take up to 3 months for your child's arthritis to improve. Not every child with arthritis who takes etanercept will see improvement. If the medicine does not help your child, your provider will discuss other options.

Etanercept is an injection given into the layer of fat under the skin (subcutaneous injection). Your team will teach you how to give the injection. Your healthcare provider will prescribe the medicine. It can be filled at a specialty pharmacy.

Side effects from etanercept are not common in children but may include:

• Upper respiratory infections (may be more frequent or longer lasting)

• Increased risk of infection

• Irritation at the injection site

• Allergic reactions

• Changes in blood cell counts like anemia, low white blood cell count, or low platelet count

• Psoriasis or rash

• Autoimmune reactions

• While there was concern for an increased risk of developing lymphoma, leukemia or other cancers, the risk has NOT been demonstrated in a number of follow up studies.

• If a patient has undiagnosed and untreated tuberculosis (TB) or hepatitis B, these diseases could reactivate.

Patient instructions:

• Your child will need blood tests before starting etanercept. Labs are then checked at 1 month and every 3-6 months after starting the medicine to monitor for side effects. Your child must have a recent negative tuberculosis test (PPD) before starting etanercept.

• Give etanercept once a week, on the same day. If you miss a dose, please call your healthcare provider. Rotate injection sites weekly.

• Remove the medicine from the refrigerator 30-60 minutes before you plan to give it so the medicine comes to room temperature. This can help with discomfort from the injection.

• Tell your other healthcare providers that your child is taking etanercept.

• Your child should not receive any live vaccines while taking etanercept. Live vaccines include MMR, varicella and the nasal flu mist. Your child should receive the flu shot, which does not contain live virus. The COVID vaccine is also recommended. Talk to your provider about when and how often your child should get this vaccine. When possible, your child should avoid contact with people who are sick.

Follow the instructions for the type of etanercept injection prescribed:

• AutoTouch® reusable autoinjector

• Single-dose prefilled SureClick® autoinjector

  • Learn more about how to give medicine from an autoinjector.

• Single-dose prefilled syringe

  • Learn more about how to give medicine from a prefilled syringe.

• Single-dose vial

  • Learn more about how to give medicine from a vial.

Instructions for storage and disposal:

• Store etanercept in the refrigerator until expiration on the syringe. Do not freeze.

• Etanercept can be stored for two weeks at room temperature. Discard the medicine if it is kept at room temperature for longer than two weeks.

• Store etanercept in the original carton to protect from light or damage.

• Handle the medicine gently. Do not shake.

• Contact your local refuse department to learn the rules for needle and syringe disposal in your area. We cannot accept used syringes in our office. More information about this can also be found at www.safeneedledisposal.org.

Contact your CHOP healthcare team with questions, concerns or if your child:

• Has a fever on the day the day they usually take etanercept. Your team will help you to determine when to take it next

• Has a fever or illness and the primary care provider is unsure of what next steps to take

• Feels very tired or weak for more than 1-2 days after taking a dose of this medicine

• Bruises easily or develops frequent nosebleeds or bleeding gums

• Has swelling or pain at an injection site that does not go away after 2-3 days

• Has been given too much medicine

Call 911 if your child has signs of an allergic reaction such as swelling of the face, lips, tongue or throat; trouble breathing, wheezing or chest tightness. If you are concerned the reaction is related to etanercept, call your healthcare team after symptoms resolve to discuss a plan moving forward.

Division of Rheumatology

215-590-2547

Reviewed on April 20, 2023, by Kirsten Spichiger, DNP, CRNP; Melissa A. Lerman, MD, PhD, MSCE; Hannah Gustafson, PharmD