Systemic Lupus Erythematosus
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
Etanercept, Infliximab, Adalimumab: Likely safe in first and early second trimester based on limited data, long-term effects unknown. Consider discontinuation, if feasible, in the second to third trimester (infliximab, adalimumab at 20 weeks and etanercept at 32 weeks) due to concern for levels of the drug in the neonate which can increase the risk of infectious complications [17, 34, 52]. This association, however, remains controversial. A recent study found similar rates of serious infections in the offspring of exposed to TNF factor inhibitor compared to those non exposed (2% exposed versus 1.9% non-exposed group) [53]. Live vaccines should be avoided in neonates and for at least 6 months when there is known exposure to TNF inhibitors during pregnancy [54, 55].
Other Immunosuppressive Agents in Vitiligo
Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan in Comprehensive Textbook on Vitiligo, 2020
TNF-α is proposed to be involved in the pathogenesis of vitiligo [17]. TNF-α potentially plays both a harmful and a protective role in vitiligo, by activating the cytotoxic T cells that are detrimental to melanocytes and stimulating T regs, respectively [18]. On this basis, etanercept, which is a TNF-α inhibitor, was used in two patients. At 6 months follow-up there was complete response [17]. In another study including six patients with progressive vitiligo, infliximab, etanercept, or adalimumab were tried. The patient receiving infliximab reported worsening of the disease while other patients reported improvement and no relapse even after 6 months of cessation of treatment [19]. Of four men treated with etanercept in another study, improvement was seen at 16 weeks of treatment [18]. There are as of today no recommendations for the use of biologics in vitiligo since the evidence is very limited.
Retinoids in Psoriasis
Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish in Retinoids in Dermatology, 2019
Biologicals are increasingly used to treat patients with moderate to severe psoriasis. Etanercept is a tumor necrosis factor-alpha receptor antagonist approved for psoriasis and psoriatic arthritis. The combination of acitretin with etanercept may increase the efficacy of treatment (28). A multicenter, randomized, open-label trial assessed the efficacy and safety of acitretin 10 mg twice daily, acitretin plus 25 mg etanercept twice weekly, and etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly. At week 24, acitretin achieved a PASI50 of 44.4% and a PASI75 of 22.2%, while the combination treatment was superior with PASI50 84.2% and PASI75 57.9%. The etanercept-only group achieved PASI50 and PASI75 of 71.4% and 52.4%. Acitretin add on obviously improved the efficacy of etanercept (40).
Rapid improvement in severe long COVID following perispinal etanercept
Published in Current Medical Research and Opinion, 2022
Edward Tobinick, Robert N. Spengler, Tracey A. Ignatowski, Manar Wassel, Samantha Laborde
Initial Food and Drug Administration (FDA) approval of etanercept in 1998 was for chronic treatment of adults with rheumatoid arthritis. Since then, largely due to its efficacy and generally favorable safety profile, it has become widely used worldwide chronically by weekly or biweekly injection for additional rheumatologic disorders, in adults and children. Etanercept is contraindicated in sepsis, and according to the manufacturer’s current package insert, when used for its labeled indications carries an increased risk of serious infections, including reactivation of latent tuberculosis, a small (less than 2%) risk of serious allergic reactions or anaphylaxis, a risk of injection site localized skin or soft tissue reactions, and, rarely, other serious adverse effects. The magnitude of these potential risks following a single dose of perispinal etanercept in an individual with long COVID who does not have underlying immunosuppression is uncertain. It would seem prudent to avoid etanercept use in individuals with a current infection, demyelinating disease, immunosuppression, lymphoma or leukemia. Further study in clinical trials will be necessary to gather additional safety data.
Anti-inflammatory activities of a new VEGF blocker, Conbercept
Published in Immunopharmacology and Immunotoxicology, 2021
The synovial release of VEGF is stimulated by hypoxia and cell factors such as TNF-α, IL-6, and TGF-β [15]. Previous studies showed that serum VEGF levels could be markedly reduced by Infliximab, a TNFα blocker [29]. Etanercept is a novel receptor decoy drug approved for the treatment of rheumatoid arthritis (RA). It can potently block TNFα activity [30]. In our study, Etanercept significantly inhibited CIA in rats and also reduced serum VEGF, TNFα, and IL-6 levels. Our results showed that inhibition of TNF also reduced the concentrations of VEGF and IL6, and vice versa, indicating that these factors could influence each other in RA. The difference of molecular weight between Conbercept and Etanercept is only 8 KD. According to our results, Conbercept needs almost three times concentrations to achieve the same effect as Etanercept. The difference in the dosage of the two drugs may be caused by the clearance rate and distribution of the drugs in rats, as well as the binding affinity with their ligands. Rheumatoid arthritis (RA) is a complex systemic disease with high expression of many cytokines such as VEGF, TNFα, IL6, etc. Next, we need to study the long-term effect of anti-VEGF drugs, as well as the combined effect of anti-VEGF and anti-TNF drugs.
The use of anti-TNF-alpha therapies for patients with systemic lupus erythematosus. Where are we now?
Published in Expert Opinion on Biological Therapy, 2021
Ana Lorenzo-Vizcaya, David A. Isenberg
Some single cases of SLE patients who received anti-TNF therapies have been published. One of these reported by Hayat et al. [35] described the safety and efficacy of infliximab given to a patient with an SLE (with WHO class IV nephritis) relapse despite conventional IS therapy. One month after infliximab, the urinary sediment ameliorated and proteinuria decreased from 3.7 g/24 h to 0.391 g/24 h, so that her steroids could be reduced. This remission was maintained 6 months after the last infusion. Another single case [2], of a patient with renal involvement treated with a TNF-alpha blocker, was young a woman with persistently active disease despite conventional treatment, with a SLEDAI score of 24. She also developed Cushing’s syndrome due to corticosteroids. Etanercept (50 mg/weekly) was given with a good response; the patient’s complement levels normalized and her SLEDAI reduced to 4. Later, she got pregnant and had a relapse of her lupus with proteinuria. The persistence of proteinuria implied ongoing active LN, so plasmapheresis and intravenous gammaglobulin (IVGG) therapy were added with a beneficial response [2]. After giving birth, a kidney biopsy confirmed the LN (WHO class IV). They concluded that etanercept may be safe and perhaps effective for SLE pregnant women with severe LN [2].
Related Knowledge Centers
- Ankylosing Spondylitis
- Fusion Protein
- Juvenile Idiopathic Arthritis
- Psoriatic Arthritis
- Tnf Inhibitor
- Tumor Necrosis Factor
- Autoimmune Disease
- Psoriasis
- Biopharmaceutical
- Tnf Inhibitor
- Rheumatoid Arthritis