Etanercept

Enbrel® Etanercept (Pfizer)

Biosimilars approved in Switzerland:
Benepali® (Biogen/Samsung Bioepis)
Erelzi® (Sandoz)

Human TNF receptor Fc fusion protein that binds TNF-α.

Plaque psoriasis in adults (all TNF-α inhibitors are also approved for psoriatic arthritis).
Paediatric approval: etanercept from 6 years of age.

No

Treatment of adult patients with severe psoriasis (defined in the Swiss S1 Guideline as PASI > 10 and/or BSA > 10 and/or DLQI > 10) in whom UVB and PUVA or one of the following three systemic therapies (cyclosporine, methotrexate, acitretin) have not been effective. For infliximab, this also requires failure of another TNF inhibitor approved for psoriasis. For adalimumab: patients with active moderate-to-severe hidradenitis suppurativa (acne inversa) who have had an inadequate response to systemic antibiotic therapy

Prefilled syringe, prefilled pen, lyophilisate for subcutaneous injection.

Differential blood count, liver enzymes, creatinine, urinalysis, SS test, CRP, screening for HBV, HCV, HIV, and TB (optional: including chest X-ray)

Blood count, liver enzymes, and CRP.

Month 3, then every 6 months.

Discontinue therapy in case of non-response after 12 weeks (for HiSCR, a response of less than 50%).

1×50 mg/week or 2×25 mg/week. Alternatively 2×50 mg/week for up to 12 weeks, 0.8 mg/kg/week for children.

In exceptional cases of severe plaque psoriasis, the dosage may be increased to a maximum of 2 × 50 mg per week for 12 weeks.

Week 12: 43.5%

Week 24: 55.3%

Week 12: 19.3%

Week 24: 27.8%

Paradoxical psoriasis may develop while taking TNF-α inhibitors. Close monitoring is required if infections occur. Live vaccines are not recommended during therapy.

Enbrel® 50 mg: 29,640

Benepali® 50 mg: 24,284

Erelzi® 50 mg: 26,260

Yes. For elective surgery, preoperative interruption for 3–5 half-lives (t1/2 = approx. 12–14 days) in selected patients (especially those with diabetes mellitus).

PASI (use PrecisePASI for greater accuracy when PASI < 10), BSA, and DLQI after 10 and 24 weeks

1.1–18%, no association with clinical response.

Absolute Contraindications: NYHA Class III–IV heart failure, active infections, live vaccines, malignant tumours within the last 5 years (except for treated epithelial tumours or cervical dysplasia), demyelinating diseases, unexplained neurological conditions (including family history), pregnancy and breastfeeding, active HBV or TB infection.

Relative contraindications: systemic lupus erythematosus; for IFX: allergies to murine antibodies, pregnancy in the first and second trimesters. Paradoxical psoriasis: (class effect) switch to another class of biologics.

Local reactions at the injection site, e.g. latex allergy, upper respiratory tract infections, pruritus, (thrombo-)cytopenia, urticaria, angioedema, lupus, multiple sclerosis, vasculitis, drug rash. Paradoxical psoriasis in 0.5%; lupus-like reactions in 0.1%.

Yes, with concurrent HBV therapy (started 3 months before anti-TNF therapy). HBV DNA and liver function tests every 2 months, in consultation with gastroenterology. Best evidence for etanercept.

Yes, monitoring of liver function and HCV-RNA; treatment in collaboration with gastroenterology; best evidence for etanercept.

Possible; decision depends on the individual case, in consultation with infectious disease specialists.

TB prophylaxis with isoniazid, rifampicin, or isoniazid + rifampicin for at least 1 month before starting treatment

Slightly increased risk of skin carcinomas, but not of other tumours.