ABSTRACT
The use of tumor necrosis factor (TNF) antagonists has significantly enhanced the treatment of moderate to severe psoriasis. Etanercept is a combination of two human TNF receptors bound to the Fc portion of an IgG1, the region that interacts with cell surface receptors to activate the complement system. This chapter reviews the structure, pharmacokinetics, side effects, efficacy, and the recommended treatment regimens of etanercept. Etanercept is a fully humanized, soluble, recombinant fusion protein that exerts its effect by competitively binding to TNF, thereby preventing it from interacting with its natural receptors and precluding its inflammatory cascade. No formal study has evaluated the use of etanercept during lactation. However, a case report of a lactating mother using etanercept twice weekly for rheumatoid arthritis revealed a small amount of excretion of etanercept in breast milk. Few studies have investigated the efficacy of acitretin in combination with etanercept. However, one potential benefit is the protective effects of acitretin against skin cancer.
