Efficacy and Safety of Etanercept in the Therapy of Arthritis

Introduction

Chronic inflammatory rheumatic diseases represent a heterogeneous group with common clinical features and genetic background. In their therapy, inhibitors of tumor necrosis factor-alpha (TNF-α) are employed, among which is the recombinant fusion protein etanercept. The aim of the cited review was to evaluate the current knowledge regarding its efficacy and safety in the treatment of psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.

Psoriatic Arthritis

Published randomized controlled clinical trials have demonstrated the superiority of etanercept over placebo in several scoring systems assessing treatment efficacy (PsARC, ACR, PASI). Compared to placebo, it also showed an effect in slowing the radiographic progression of the disease. The efficacy of etanercept has been further confirmed in long-term therapy for psoriatic arthritis, with a noticeable decrease in the concomitant use of other disease-modifying drugs and corticosteroids.

The efficacy of etanercept has been proven in both axial and peripheral joint damage in psoriatic arthritis. Studies have also shown a significant positive impact on improving endothelial function, reducing the risk of cardiovascular and cerebrovascular events, and improving the quality of life of patients with psoriatic arthritis.

The safety profile results were consistent with the known safety profile of the drug. In some studies, a lower risk of serious infections compared to adalimumab and infliximab was observed. In patients infected with hepatitis C virus (HCV), etanercept even appears as a therapeutic option.

Intra-articular administration of etanercept, compared to placebo, showed significant effects without serious adverse events, suggesting this local therapy option could be further developed in the future.

Ankylosing Spondylitis

The efficacy of etanercept in the therapy of ankylosing spondylitis has also been confirmed by several clinical studies. In a study comparing etanercept with infliximab, the efficacy of both treatment modalities was demonstrated, but infliximab led to faster clinical improvement. However, another study observed the superiority of etanercept in treatment retention compared to infliximab. The same study confirmed the significant efficacy of etanercept in the therapy of ankylosing spondylitis.

Compared to sulfasalazine, etanercept was superior in clinical efficacy, and both treatment modalities were well tolerated. In patients with low bone density, therapy with etanercept, compared to placebo, showed improvement, which was also noted in bone metabolism parameters.

A meta-analysis of clinical studies revealed a significant clinical effect of etanercept on extra-articular manifestation, such as uveitis. However, uveitis can also be a potential adverse effect of the treatment according to the authors. The incidence of idiopathic inflammatory bowel disease showed no significant difference between etanercept, placebo, and other TNF-α inhibitors in the meta-analysis.

Juvenile Idiopathic Arthritis

The efficacy and safety of etanercept in the therapy of juvenile idiopathic arthritis have also been proven in published clinical studies for both short-term and long-term administration. Independent predictors of achieving sustained clinical improvement or minimal disease activity include shorter disease duration, absence of concomitant use of oral corticosteroids, a history of chronic anterior uveitis, and age < 9 years.

Concomitant use of methotrexate in patients with juvenile idiopathic arthritis showed a significantly lower incidence of idiopathic inflammatory bowel disease, making combination therapy with methotrexate a protective factor.

Conclusion

The results of published studies indicate that etanercept is an effective and safe modality for the therapy of psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis. The most frequently reported adverse events during treatment include nasopharyngitis, upper respiratory tract infections, cough, headache, fatigue, and skin and subcutaneous tissue disorders.

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Source: Murdaca G., Negrini S., Magnani O. et al. Update upon efficacy and safety of etanercept for the treatment of spondyloarthritis and juvenile idiopathic arthritis. Mod Rheumatol 2018; 28 (3): 417–431, doi: 10.1080/14397595.2017.1366006.