Psoriatic arthritis in adolescents who have had an
inadequate response to methotrexate or who cannot
tolerate it|Enthesitis-related arthritis in adolescents
who have had an inadequate response to conventional
therapy or who cannot tolerate it
▶BY SUBCUTANEOUS INJECTION
▶Child 12–17 years: 800 micrograms/kg once weekly (max.
per dose 50 mg), consider discontinuation if no
response after 4 months
Chronic, severe plaque psoriasis in children who have had
an inadequate response to other systemic therapies or
phototherapies or who cannot tolerate them
▶BY SUBCUTANEOUS INJECTION
▶Child 6–17 years: 800 micrograms/kg once weekly (max.
per dose 50 mg) for up to 24 weeks, discontinue if no
response after 12 weeks
ENBREL®POWDER AND SOLVENT FOR SOLUTION FOR
INJECTION
Polyarthritis in children who have had an inadequate
response to methotrexate or who cannot tolerate it|
Extended oligoarthritis in children who have had an
inadequate response to methotrexate or who cannot
tolerate it
▶BY SUBCUTANEOUS INJECTION
▶Child 2–17 years: 400 micrograms/kg twice weekly (max.
per dose 25 mg), to be given at an interval of 3 — 4 days
between doses, alternatively 800 micrograms/kg once
weekly (max. per dose 50 mg), consider
discontinuation if no response after 4 months
Psoriatic arthritis in adolescents who have had an
inadequate response to methotrexate or who cannot
tolerate it|Enthesitis-related arthritis in adolescents
who have had an inadequate response to conventional
therapy or who cannot tolerate it
▶BY SUBCUTANEOUS INJECTION
▶Child 12–17 years: 400 micrograms/kg twice weekly
(max. per dose 25 mg), to be given at an interval of
3 — 4 days between doses, alternatively
800 micrograms/kg once weekly (max. per dose 50 mg),
consider discontinuation if no response after 4 months
Chronic, severe plaque psoriasis in children who have had
an inadequate response to other systemic therapies or
phototherapies or who cannot tolerate them
▶BY SUBCUTANEOUS INJECTION
▶Child 6–17 years: 800 micrograms/kg once weekly (max.
per dose 50 mg) for up to 24 weeks, discontinue if no
response after 12 weeks
ENBREL®SOLUTION FOR INJECTION
Polyarthritis in children who have had an inadequate
response to methotrexate or who cannot tolerate it|
Extended oligoarthritis in children who have had an
inadequate response to methotrexate or who cannot
tolerate it
▶BY SUBCUTANEOUS INJECTION
▶Child 2–17 years: 400 micrograms/kg twice weekly (max.
per dose 25 mg), to be given at an interval of 3 – 4 days
between doses, alternatively 800 micrograms/kg once
weekly (max. per dose 50 mg), consider
discontinuation if no response after 4 months
Psoriatic arthritis in adolescents who have had an
inadequate response to methotrexate or who cannot
tolerate it|Enthesitis-related arthritis in adolescents
who have had an inadequate response to conventional
therapy or who cannot tolerate it
▶BY SUBCUTANEOUS INJECTION
▶Child 12–17 years: 400 micrograms/kg twice weekly
(max. per dose 25 mg), to be given at an interval of
3 – 4 days between doses, alternatively
800 micrograms/kg once weekly (max. per dose 50 mg),
consider discontinuation if no response after 4 monthsChronic, severe plaque psoriasis in children who have had
an inadequate response to other systemic therapies or
phototherapies or who cannot tolerate them
▶BY SUBCUTANEOUS INJECTION
▶Child 6–17 years: 800 micrograms/kg once weekly (max.
per dose 50 mg) for up to 24 weeks, discontinue if no
response after 12 weekslCONTRA-INDICATIONSActive infection.avoid injections
containing benzyl alcohol in neonates
lCAUTIONSChildren should be brought up to date with
current immunisation schedule before initiating therapy.
development of malignancy.diabetes mellitus.heart
failure (risk of exacerbation).hepatitis B virus—monitor
for active infection.hepatitis C infection (monitor for
worsening infection).history of blood disorders.history of
malignancy.history or increased risk of demyelinating
disorders.predisposition to infection (avoid if
predisposition to septicaemia).significant exposure to
herpes zoster virus—interrupt treatment and consider
varicella–zoster immunoglobulin
CAUTIONS, FURTHER INFORMATION
▶TuberculosisActive tuberculosis should be treated with
standard treatment for at least 2 months before starting
etanercept. Patients who have previously received
adequate treatment for tuberculosis can start etanercept
but should be monitored every 3 months for possible
recurrence. In patients without active tuberculosis but
who were previously not treated adequately,
chemoprophylaxis should ideally be completed before
starting etanercept. In patients at high risk of tuberculosis
who cannot be assessed by tuberculin skin test,
chemoprophylaxis can be given concurrently with
etanercept.
lINTERACTIONS→Appendix 1 : etanercept
lSIDE-EFFECTS
▶Common or very commonCystitis.fever.hypersensitivity.
increased risk of infection.pain.skin reactions.swelling
▶UncommonAbscess.bursitis.cholecystitis.diarrhoea.
endocarditis.eye inflammation.gastritis.hepatic
disorders.myositis.neoplasms.respiratory disorders.
sepsis.skin ulcers.thrombocytopenia.vasculitis
▶Rare or very rareAnaemia.bone marrow disorders.
congestive heart failure.cutaneous lupus erythematosus.
demyelination.leucopenia.lupus-like syndrome.nerve
disorders.neutropenia.sarcoidosis.seizure.severe
cutaneous adverse reactions (SCARs).transverse myelitis
▶Frequency not knownAbdominal pain.depression.
dermatomyositis exacerbated.headache.hepatitis B
reactivation.inflammatory bowel disease.macrophage
activation syndrome.nausea.personality disorder.post
procedural infection.type 1 diabetes mellitus.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONAssociated with
infections, sometimes severe, including tuberculosis,
septicaemia, and hepatitis B reactivation.
lCONCEPTION AND CONTRACEPTIONManufacturer advises
effective contraception required during treatment and for
3 weeks after last dose.
lPREGNANCYAvoid—limited information available.
lBREAST FEEDINGManufacturer advises avoid—present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTUse with caution in moderate to
severe alcoholic hepatitis.
lPRE-TREATMENT SCREENING
TuberculosisPatients should be evaluated for tuberculosis
before treatment.
lMONITORING REQUIREMENTSMonitor for skin cancer
before and during treatment, particularly in those at risk
(including patients with psoriasis or a history of PUVA
treatment).644 Arthritis BNFC 2018 – 2019
Musculoskeletal system10