The safety of etanercept for the treatment of plaque psoriasis

Figures & data

Table 1 Introducing therapy

Contraindications

Hypersensitive reactions to etanercept

Active infection

Septic arthritis within 12 months

Active or personal history of demyelination

Hematological dyscrasia

Septicemia

Relative contraindication

Pregnancy or breast-feeding

NYHA grade 3 or 4 heart failure

First degree relative with history of demyelinating disease

Prior hematologic dyscrasia

Frequent infections

Open wounds, chronic or recurrent ulceration

Insulin resistance

Abbreviations: NYHA, New York Heart Association.

Table 2 Initiation and maintenance of therapy

A. Discontinue during administration of antibiotics

B. Consider comorbidity

RA: Hypertension (15%) increased risk of CHF; Diabetes (6%) increased risk of hypoglycemia; Cardiac ischemia (4%) (BIOBADASER, June 2003)

C. CXR to exclude active TB

D. Consider PPD to exclude latent TB (this is suggested for all TNF-antagonists by many. However, there is no evidence supporting activation of latent TB in patients treated with etanercept)

E. Surgery: Discontinue etanercept 1–2 weeks prior and recommence 2 weeks following uncomplicated recovery

F. Vaccination: discontinue 4 weeks prior to and re-instate 4 weeks post (based upon potential depressed efficacy rather than safety considerations)

G. Discontinue in the event of a malignancy with the exception of cutaneous basal cell carcinoma.

H. Periodic CBC and ALT (every 3 months)

I. Periodic ANA (once yearly)

J. Periodic history regarding signs and symptoms of opportunistic infections

K. Annual cutaneous examinations for malignancy

L. In the event of pregnancy, appropriate review of risk-benefit

Abbreviations: ALT, alanine aminotransferase; CBC, complete blood count;CHF, congestive heart failure; CXR, chest X-ray; PPD, tuberculin; RA, rheumatoid arthritis; TB, tuberculosis.