What are the alternatives to Enbrel® ?

Enbrel® is approved for the treatment of a wide variety of diseases and the alternatives to the drug are therefore primarily based on the disease to be treated. For the treatment of psoriasis, drugs in the form of ointments are usually used first and often no additional drugs such as Enbrel® or similar products need to be taken. In the case of rheumatic diseases, cortisone preparations and the drug methotrexate are not only alternatives but also first-choice drugs.

Accordingly, for all other diseases for which Enbrel® is suitable for treatment, there are usually a large number of alternative treatment options. Biologics are protein substances that are produced biotechnologically and inhibit inflammatory reactions in the body. The mechanism of action of biologicals is based on blocking the body’s inflammatory messenger substances.This is used in the treatment of chronic inflammatory diseases. Enbrel® or its active ingredient Etanercept. is directed against the particularly important messenger substance “tumor necrosis factor-alpha”.

Side effects

As the drug inhibits a central mediator of the immune system, it influences not only pathological, i.e. pathological, but also physiological, i.e. health-promoting and necessary inflammatory reactions that cause a defence against microorganisms (bacteria, viruses, parasites, etc.) and other harmful influences.

Since everyone reacts differently to medicines, the side effects mentioned below need not occur, but they are possible. Allergic reactions, which may manifest themselves as swelling of the face, throat or extremities. There may also be severe skin rashes with itching and hives.

Very often, i.e. in more than 10% of users, infections such as colds, bronchitis or urinary tract infections occur. Reactions at the injection site, which manifest themselves as local redness, bleeding or pain. Frequently, 1-10% of users experience fever or the formation of autoantibodies (antibodies that are falsely produced against their own body tissue).

Occasionally, up to 1% of users may develop serious infections such as lung infections, blood infections or joint infections. In addition, skin cancer (except melanoma), a reduced platelet count (high risk of bleeding and bruising), inflammation of the eyes, lungs including scarring, and blood vessels may occur. In rare cases, up to 0.1% of users may develop lymphomas or melanomas (both forms of cancer).

Furthermore, sarcoidosis (an inflammatory immune disease affecting the whole body), serious damage to the nervous system including severe muscle weakness and other symptoms similar to those of nervous system diseases such as multiple sclerosis or spinal cord inflammation may occur. In addition, there is an isolated or combined reduction of all types of cellular components of the blood such as red blood cells, neutrophil granulocytes (a type of white blood cell) and platelets (thrombocytes). In addition, lupus or lupus-like symptoms may occur.

Tuberculosis infection may flare up again (e.g. there may be an acute outbreak of a silent, latent infection) or inflammation of the liver with elevated liver values may occur, caused by the body itself, also known as autoimmune hepatitis.

Allergic reactions which can manifest themselves as swelling of the face, throat or extremities. Severe skin rashes with itching and hives may also occur.
Very often, more than 10% of users suffer from infections such as colds, bronchitis or urinary tract infections.
Reactions at the puncture site that manifest themselves as local redness, bleeding or pain.
Frequently, 1-10% of users experience fever or the formation of autoantibodies (antibodies that are falsely produced against their own body tissue).
Occasionally, in up to 1% of users, serious infections such as a lung infection, blood infection or joint infection can occur.
In addition, skin cancer (except melanoma), a reduced platelet count (high risk of bleeding and bruising), inflammation of the eyes, lungs including scarring, and blood vessels may occur.
Rarely, up to 0.1% of users may develop lymphoma or melanoma (both forms of cancer). Furthermore, sarcoidosis (an inflammatory immune disease affecting the whole body), serious damage to the nervous system including severe muscle weakness and other symptoms similar to those of nervous system diseases such as multiple sclerosis or spinal cord inflammation may occur. In addition, there is an isolated or combined reduction of all types of cellular components of the blood such as red blood cells, neutrophil granulocytes (a type of white blood cell) and platelets (thrombocytes).
In addition, lupus or lupus-like symptoms may occur. Tuberculosis infection may flare up again (e.g. there may be an acute outbreak of a silent, latent infection) or inflammation of the liver with elevated liver values may occur, caused by the body itself, also known as autoimmune hepatitis.

Very rarely, less than 0.01% of users may experience general bone marrow dysfunction and associated serious disturbance of blood cell formation, since the bone marrow is the main site of blood cell formation in adults. In individual cases, a certain form of skin cancer (Merkel cell carcinoma), recurrence of a certain form of virus-induced liver inflammation (hepatitis B), worsening of dermatomyositis (inflammatory changes in the muscles and skin), leukemia (a form of blood cancer) or an excessive inflammatory reaction affecting the whole body, which occurs due to excessive activation of macrophages and is called macrophage activation syndrome.

Very rarely, less than 0.01% of users may experience general bone marrow dysfunction and associated serious disturbance of blood cell formation, since the bone marrow is the main site of blood cell formation in adults.

Fatigue is a rather unspecific symptom that can have a variety of possible causes. Under certain circumstances, it can also occur as a side effect of Enbrel®. In very rare cases, for example, it is possible that the drug leads to a reduced production of red blood cells.

Any resulting anemia can initially manifest itself as fatigue. Similarly, treatment with Enbrel® may lead to more frequent illnesses such as a urinary tract infection or a cold, which can also lead to fatigue. In addition, however, symptoms such as coughing and rhinitis or burning sensation when urinating normally also occur.

Severe illnesses caused by the medication can also lead to fatigue. If in doubt, it is best to consult the doctor who prescribed Enbrel® to find out whether the fatigue may be related to the intake of Enbrel®. In some cases, treatment with Enbrel® may actually promote or trigger the occurrence of certain cancers.

These include, on the one hand, cancers affecting the blood system, which are known as leukaemia. On the other hand, a special form of skin cancer (Merkel cell carcinoma) can occur more frequently. In contrast to other possible side effects of Enbrel, however, it is not possible to say how often cancer is caused by taking the drug.

This is due to the fact that the current knowledge from scientifically collected data is not sufficient to assess this. Patients taking Enbrel® must therefore be examined regularly. If a serious illness such as cancer occurs, it can at best be treated early.

A skin rash is a relatively common possible side effect of Enbrel®. It usually occurs as part of an allergic reaction to the active ingredient of the drug. Other possible symptoms include shortness of breath, fever and itching.

However, the rash can also occur without any other signs of an allergic reaction. The rash can develop immediately after the injection of the syringe, but also delayed after a few hours or days. It is possible that the skin is affected all over the body or only individual parts of the body show the rash.

However, since a rash can have many other possible causes, the treating physician should be consulted if a side effect is suspected. If necessary, treatment with Enbrel® may have to be discontinued. Only in serious cases do drugs have to be administered to treat the allergic reaction.

Weight gain is not usually expected during treatment with Enbrel®. If there is an increase in body weight during treatment with the drug, this usually has a different cause. In most cases, a higher calorie intake with food than calorie consumption (through physical activity) is responsible.

Under certain circumstances, however, Enbrel® may in rare cases actually be responsible for rapid weight gain: If, as a side effect, the pumping function of the heart deteriorates (cardiac insufficiency), water deposits may form in the legs (edema). In addition to an increase in body weight, there is usually a noticeable and visible swelling of the ankles and lower legs. In such a case, consultation with the doctor treating the patient should be sought.