Etanercept for treating axial spondyloarthritis

ABSTRACT

Introduction: Axial spondyloarthritis is an inflammatory rheumatic disease causing back pain, functional impairment and potential ankylosis in the advanced stage. In this context, TNF blockers have been a major therapeutic advance. Etanercept is a soluble recombinant TNF receptor fusion protein in this vain.

Areas covered: The aim of this review is to summarize the current published data concerning the efficacy and tolerance of etanercept in axial spondyloarthrits. The authors performed a systematic review on PubMed, using ‘etanercept’ and ‘spondyloarthritis’, ‘axial spondyloarthritis’ or ‘ankylosing spondylitis’ keywords.

Expert opinion: Etanercept showed clinical efficacy on the axial (non-radiographic and radiographic) and peripheral manifestations (peripheral arthritis and enthesitis) of axial spondyloarthritis (Ax-SpA). Among the extra-articular manifestations, it works on psoriasis but not on inflammatory bowel disease, with a lack of efficacy data in anterior uveitis. Etanercept also demonstrated an interesting tolerance profile and good drug survival rates after 5 years. Etanercept was also shown to reduce MRI inflammation on the spine and the sacroiliac joints. However, like other TNF blockers, its impact on radiographic progression could not be fully demonstrated. In the context of upcoming new biologic targeted treatments, head-to-head and longer-term randomized controlled trials are now required to further define the role of etanercept in spondyloarthritis treatment strategies.

KEYWORDS:

• Axial spondyloarthritis
• Etanercept
• TNF receptor
• efficacy
• safety
• radiographic progression
• MRI
• outcome definition

Box 1. Drug summary

Declaration of interest

D Wendling has received speaker’s fees from AbbVie, Amgen Inc, Bristol-Myers Squibb, Celgene, Chugai Pharmaceutical Co. Ltd, Eli Lilly and Company, Hospira, Janssen Pharmaceuticals, Merck Sharp and Dohme, Novartis, Pfizer Inc, Roche, Sandoz and UCB Pharma. They are also on the advisory boards of Novartis, Sandoz and Celgene. Furthermore, they’ve received travel support from Roche, Chugai Pharmaceutical Co. Ltd, Merck Sharp and Dohme, Nordic Pharma, UCB Pharma and Janssen Pharmaceuticals and received grants from Hospira, Chugai Pharmaceutical Co. Ltd, and Pfizer Inc. In addition, they are a national (France) coordinator on the international study MEASURE 1 by Novartis. C Prati has received speaker’s fees from Bristol-Myers Squibb, UCB Pharma, Novartis, Roche and Chugai Pharmaceutical Co. Ltd. They are also on the advisory board of Eli Lilly and Company and Novartis and have also received travel support from Nordic Pharma, Janssen Pharmaceuticals, UCB Pharma, Roche and Chugai. They’ve also received grant support from Pfizer Inc. X Guillot has received speaker’s fees from Bristol-Myers Squibb and has also received travel support from Roche, Chugai Pharmaceutical Co. Ltd, Merck Sharp and Dohme, Nordic Pharma, UCB Pharma, Novartis and AbbVie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript has not been funded.