IN THE UK, ITS USE IS USUALLY LIMITED TO PATIENTS WHO HAVE HAD AN INADEQUATE RESPONSE TO STANDARD DISEASE-MODIFYING ANTIRHEUMATIC DRUGS ALTHOUGH, IN SEVERE RHEUMATOID ARTHRITIS, IT MAY BE USED IN PATIENTS NOT PREVIOUSLY TREATED WITH METHOTREXATE. IN THE USA, IT MAY BE USED FOR TREATING EARLY RHEUMATOID ARTHRITIS OR PSORIATIC ARTHRITIS, TO REDUCE THE SIGNS AND SYMPTOMS AND DELAY STRUCTURAL DAMAGE. IN BOTH INDICATIONS, IT IS GIVEN AS A SUBCUTANEOUS INJECTION IN A DOSE OF 25 MG TWICE WEEKLY AT INTERVALS OF 3 OR 4 DAYS. THE EQUIVALENT WEEKLY DOSE OF 50 MG MAY ALSO BE GIVEN EITHER AS A SINGLE 50-MG INJECTION OR AS TWO SEPARATE 25-MG INJECTIONS (GIVEN AT ABOUT THE SAME TIME). IN THE UK, NICE RECOMMENDS, BASED ON GUIDELINES FROM THE BRITISH SOCIETY OF RHEUMATOLOGY, THAT TREATMENT BE DISCONTINUED IF THERE IS NO RESPONSE AFTER 3 MONTHS. ETANERCEPT IS ALSO INDICATED IN THE TREATMENT OF ANKYLOSING SPONDYLITIS IN DOSES SIMILAR TO THOSE USED FOR RHEUMATOID ARTHRITIS.
ETANERCEPT IS ALSO USED IN THE TREATMENT OF UNRESPONSIVE MODERATE TO SEVERE POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS IN CHILDREN AND ADOLESCENTS AGED 4 YEARS AND OVER. IN THE UK, IT IS GIVEN SUBCUTANEOUSLY IN A DOSE OF 400 MICROGRAMS/KG (UP TO A MAXIMUM DOSE OF 25 MG) TWICE WEEKLY AT INTERVALS OF 3 OR 4 DAYS. SIMILAR DOSES ARE ALSO USED IN THE USA ALTHOUGH DOSES ARE EXPRESSED AS 800 MICROGRAMS/KG (UP TO A MAXIMUM DOSE OF 50 MG) WEEKLY: FOR PATIENTS WEIGHING 63 KG OR MORE A DOSE OF 50 MG MAY BE GIVEN ONCE WEEKLY; THOSE WEIGHING BETWEEN 31 AND 62 KG MAY BE GIVEN THE TOTAL WEEKLY DOSE AS 2 SEPARATE INJECTIONS, EITHER ON THE SAME DAY OR 3 TO 4 DAYS APART; CHILDREN UNDER 31 KG SHOULD BE GIVEN A SINGLE INJECTION ONCE WEEKLY. IN THE UK, NICE RECOMMENDS, BASED ON GUIDELINES FROM THE BRITISH PAEDIATRIC RHEUMATOLOGY GROUP, THAT TREATMENT BE DISCONTINUED IN CHILDREN IF THERE IS NO RESPONSE AFTER 6 MONTHS, OR AN INITIAL RESPONSE IS NOT MAINTAINED.
ETANERCEPT IS ALSO USED IN THE TREATMENT OF CHRONIC, MODERATE TO SEVERE PLAQUE PSORIASIS IN PATIENTS AGED OVER 18 YEARS. IN THE UK, ITS USE IS USUALLY LIMITED TO PATIENTS IN WHOM OTHER SYSTEMIC TREATMENTS ARE NOT SUITABLE. THE RECOMMENDED INITIAL DOSE IS 25 MG TWICE WEEKLY. ALTERNATIVELY, AN INITIAL DOSE OF 50 MG TWICE WEEKLY AT INTERVALS OF 3 OR 4 DAYS MAY BE GIVEN FOR 12 WEEKS; THE DOSE SHOULD THEN BE REDUCED TO 25 MG TWICE WEEKLY OR 50 MG WEEKLY. INITIAL DOSES OF 25 OR 50 MG ONCE WEEKLY HAVE ALSO BEEN SHOWN TO BE EFFECTIVE. TREATMENT SHOULD CONTINUE UNTIL REMISSION IS ACHIEVED, FOR UP TO 24 WEEKS. TREATMENT SHOULD BE STOPPED AFTER 12 WEEKS IN PATIENTS WHO SHOW NO RESPONSE.
PSORIASIS.
ETANERCEPT IS EFFECTIVE IN PATIENTS WITH MODERATE TO SEVERE PLAQUE PSORIASIS; EFFICACY APPEARS TO BE DOSE-RELATED WITH 25% OF PATIENTS IN THE LOW-DOSE (25 MG ONCE WEEKLY) GROUP SHOWING AT LEAST A 75% IMPROVEMENT COMPARED TO 59% IN THE HIGH-DOSE GROUP (50 MG TWICE WEEKLY) AFTER 24 WEEKS OF ETANERCEPT TREATMENT. A LATER MULTICENTRE STUDY IN PATIENTS WITH CHRONIC PLAQUE PSORIASIS FOUND THAT THE THERAPEUTIC EFFECT OF ETANERCEPT WAS MAINTAINED WHEN THE DOSE WAS REDUCED AFTER 12 WEEKS FROM 50 MG TWICE WEEKLY TO 25 MG TWICE WEEKLY.