Etanercept
Enbrel® Etanercept ETA
Pfizer
Human TNF receptor Fc fusion protein which binds to TNF-α
Plaque psoriasis in adults, in ETA, IFX, ADA, UST, SEC and IXE also psoriatic arthritis, in ETA: indicated from 6 years of age
Yes (Infliximab: in case of failure of a previous TNF inhibitor therapy)
Treatment of adult patients with severe psoriasis (Def. in USZ and Swiss S1 Guideline): PASI > 10 or BSA > 10 and/or DLQI > 10) in which UVB and PUVA or one of the following three systemic rapias (ciclosporin, methotrexate, acitretin) have shown no therapeutic success. In iximab, additional failure of another TNF blocker approved for psoriasis.
Ready-to-use syringe, pen, lyophilisate
Blood count, liver enzymes, creatinine, U status, pregnancy test in urine, CRP/ ESR. Screening for HBV, HCV, HIV and tuberculosis including Rx thorax. Optional: ANA, HLA-Cw6 (personalized medicine as not yet validated response predictor for Ustekinumab)
Blood count, CRP, liver transaminases, creatinine, possibly β-HCG
Month 1, 3, then every 3 months
Month 1, 3, then every 3 months
s.c.
1x 50 mg/week or 2x 25 mg/week . Alternatively 2x 50 mg/week for up to 12 weeks. 0.8 mg/kg/week for children.
4 - 8 weeks
Week 12: 43.5 % Week 24: 55.3 % (50 mg biw)
Week 12: 19.3 % Week 24: 27.8 % (50 mg biw)
24'516.70 (30'174.40) (50 mg biw to wk 12, then qw)
Yes
PASI, (use PrecisePASI for greater accuracy once PASI < 10), DLQI after 10 and 24 weeks
1.1 - 18 %, no association with clinical response
Absolute contraindications: Heart disease NYHA III-IV, active infections, live vaccinations, malignant tumors in the last 5 years, except treated epithelial tumors or cervical dysplasia, demyelinating diseases, unclear neurological conditions (including family history). Pregnancy and breastfeeding. Active HBV/Tbc infection. Relative contraindications: systemic lupus erythematosus. In IFX: Allergies to murine antibodies.
Local reactions at the injection site e.g. latex allergy, upper respiratory tract infections, pruritus, (thrombocytopenia) cytopenia, urticaria, angioedema, lupus, multiple sclerosis, vasculitis, drug xant hem. In 0.5 % paradoxical psoria sis, in 0.1 % lupus-like reactions
Yes, with simultaneous HBV therapy (start 3 months before anti-TNF therapy). HBV DNA and liver function every 2 months, together with gastroenterology. Best evidence at Etanercept
Yes, monitoring of liver function and HCV-RNA, therapy together with gastroenterology. Best evidence with Etanercept
Possible, case-dependent decision, together with infectiology
Anakinra, Abatacept
Cancer risk is slightly increased for skin cancers, but not other tumors
Inj. Lsg.
systemic