Systemic Therapy for Psoriasis

Melvin Lee, MD; Robert E. Kalb, MD


Dermatology Nursing. 2008;20(2):105-111. 

In This Article

Etanercept (Enbrel®)

Etanercept is a fusion protein consisting of two tumor necrosis factor (TNF) receptors linked to the Fc protein of human immunoglobulin (IgG). It works by inhibiting the pro-inflammatory action of TNF in psoriasis.

Patients inject the medication subcutaneously, with dosing either at 50 mg weekly (either as a single dose or divided into two doses) or 50 mg twice a week for 12 weeks followed by a decrease to the 50 mg weekly maintenance dosing. The regimen with higher initial dosing has been shown to clear psoriatic lesions faster; however, a recent study has shown that patients on both dosing schedules achieve the same endpoint at 1 year (Sterry, 2004). Thus, consideration should be made to dose patients starting at 50 mg weekly, which is less costly and achieves the same result at 1 year.

A common side effect of etanercept is a transient injection reaction (Zeltser et al., 2001). More serious rare reactions include serious infections (including tuberculosis), demyelinating disease, aplastic anemia, and an increased incidence of malignancy (Bongartz et al., 2006; Setoguchi et al., 2006).

With incomplete response to etanercept, it may be combined with other therapies including NB-UVB, acitretin, or methotrexate (Conley, Nanton, Dhawan, Pearce & Feldman, 2006; Gul et al., 2006). Incomplete responses or failures may necessitate a switch to infliximab, adalimumab, or efalizumab (Farnsworth, George, & Hsu, 2005; Wick, 2005). Some studies have suggested that some patients treated with etanercept may lose efficacy over time (Tyring, Poulin, Langley, & Gordon, 2006). If a previously stable patient on etanercept flares, cyclosporine may be used temporarily to control the disease (Pedraz, Sanz, & Garcia-Diez, 2007).


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