Etanercept Monotherapy — SCE Rheumatology MCQ

Correct answer: A — Etanercept may be used alone when methotrexate is unsuitable; anti-etanercept antibodies are usually transient and non-neutralising, although combination treatment is more effective.

Etanercept is a soluble p75 TNF-receptor–Fc fusion protein and is licensed for monotherapy when methotrexate is not tolerated or continued methotrexate is inappropriate. Anti-etanercept antibodies occur infrequently in rheumatoid arthritis and are generally transient, non-neutralising and not correlated with reduced response. This contrasts with the clinically important immunogenicity described particularly with monoclonal anti-TNF agents such as infliximab and adalimumab. Nevertheless, monotherapy should not be presented as equivalent: the TEMPO trial demonstrated superior clinical, functional and radiographic outcomes with etanercept plus methotrexate compared with either agent alone. Therefore B and C give incorrect pharmacological rationales, while A denies the additional efficacy of combination treatment. E reverses the evidence: etanercept and methotrexate are routinely combined when methotrexate is tolerated.

Reference: Enbrel 50 mg solution for injection in pre-filled pen, Summary of Product Characteristics, sections 4.1 and 5.1, updated 24 June 2024. https://www.medicines.org.uk/emc/product/11739/smpc