Disease modifying anti-rheumatic drugs (DMARDs) is a group of drugs that slow or stop the immune system from destroying the joints. These drugs do not have immediate analgesic or anti-inflammatory effect. These drugs have long term beneficial effects in controlling disease activity.

These agents also have an important role in reducing the long-term exposure to medications such as prednisolone and non-steroidal anti-inflammatory drugs (NSAIDs). Theses drugs indicated for the treatment of inflammatory arthritis including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS).

Etanercept is a soluble tumour necrosis factor α‐receptor disease‐modifying anti‐rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). In people with rheumatoid arthritis who have NOT improved with a traditional disease‐modifying anti‐rheumatic drug (DMARD):

• Etanercept plus conventional DMARDs probably improves pain, function and other symptoms of rheumatoid arthritis;
• Etanercept plus conventional DMARDs reduces disease activity and disability
• Etanercept reduces permanent joint damage as seen on x‐ray.

• Any kind of infection including an infection that is in only one place in your body (such as an open sore), or an infection that is in your whole body (such as the flu)
• A history of infections that keep coming back or other conditions, like diabetes, that might increase your risk of infections.
• Tuberculosis (TB), or if you have been in close contact with someone who has had tuberculosis. If you develop any of the symptoms of tuberculosis (a dry cough that doesn’t go away, weight loss, fever, night sweats) call your doctor. You will need to be examined for TB and have a skin test.
• Any numbness or tingling or a disease that affects your nervous system like multiple sclerosis.
• Been newly diagnosed or are being treated for congestive heart failure.
• Been scheduled to have major surgery.
• Been scheduled to be vaccinated for anything.

Etanercept not recommended for use in pregnant and lactating women.

Reference –Etveza Pack Insert

Keep out of reach of children. Protect it from light and moisture. Store between 2°-8°C. Do not freeze. It has storage life of 36 months

Reference –Etveza Pack Insert

Q(6A) What's the dosage for adults?

In rheumatoid arthritis: 25 mg Etanercept administered twice weekly is the recommended dose. Alternatively, 50 mg administered once weekly has been shown to be safe and effective.

Psoriatic arthritis and ankylosing spondylitis: The recommended dose is 25 mg Etanercept administered twice weekly, or 50 mg administered once weekly.

Plague psoriasis: The recommended dose of Etanercept is 25mg administered twice weekly or 50 mg administered once weekly.

Reference –Etveza Pack Insert

Q(6B) What if the patient missed the dose?

Instruct the patient to remember the dose. If one forget to use, inject the dose as soon as patient recall the same. Ask the patient to take his/her next dose at regularly scheduled time.

Remember, if it is almost time for the next dose, instruct the patient to skip the missed dose and continue the usual dosing schedule. Patient should not inject a double dose to make up for a missed one.

Link - http://etveza.rayadcomm.com/how-to-administer/

The most common reaction is the local reaction at injection site, including mild to moderate redness, itching, pain and swelling, which usually starts at the first month of treatment, and the frequency will decrease in the following treatment.

Reference –Etveza Pack Insert

• Etveza may be left unrefrigerated for up to 14 days, as long as it is protected from light and not exposed to heat.
• Once Etveza has been taken out of the refrigerator for more than 15 minutes, do not put it back in the refrigerator.
• If Etveza has not been used within 14 days of being taken out of the refrigerator, discard it.

You should not be given any live vaccines, like the chicken pox vaccine, the shingles vaccine or the measles vaccines, while on Etveza. The flu-shot (flu injection vaccine) is not a live virus and all patients should consider having this vaccination yearly.

Uncommon: Serious infections (including pneumonia, cellulitis, septic arthritis, sepsis and parasitic infection)

Very common: Infections (including upper respiratory tract infections, bronchitis, cystitis, skin infections)

Rare: Tuberculosis, opportunistic infections (including invasive fungal, protozoal, bacterial and atypical mycobacterial infections and Legionella)

Reference –Etveza Pack Insert

WARNING AND PRECAUTION

1. When repeated upper respiratory tract infection or obvious tendency of infection occurs during administration of Etanercept, consultation of a doctor is recommended.
2. Serious infections (sepsis, lethal and life threatening infections) occurred in the patients who received the like product abroad, therefore the administration of Etanercept should be cautious to the patients with history of repeated infectious diseases or latent diseases easily leading to infection,
3. When serious infection occurs such as infection secondary to diabetes, tuberculosis infection etc, the administration of Etanercept should be discontinued temporarily.
4. During the using of Etanercept, allergic reactions including angio-edema, urticaria and other reactions should be concerned. Once the allergic reaction occurs, Etanercept therapy should be discontinued immediately and appropriate medical treatment should be given.
5. Since Etanercept can regulate inflammatory and cell immune reactions, its influence on anti-infection and anti-tumour therapy should be considered when using Etanarcept.
6. No data are available on the secondary transmission of infection by live vaccines in patients receiving Etanercept. The concurrent vaccination of live vaccines is not recommended when receiving Etanercept.
7. It was reported overseas that Etanercept may lead to the exacerbation of patients with congestive heart failure, so administration of Etanercept in patients with heart failure should be extremely cautious.

Reference –Etveza Pack Insert