[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [TNF inhibitors](https://durgical.com/en/pharmacology/classes/tnf-inhibitors/) › Etanercept

[Pharmacology](https://durgical.com/en/pharmacology/) · [TNF inhibitors](https://durgical.com/en/pharmacology/classes/tnf-inhibitors/)

# Etanercept

A decoy TNF receptor joined to an antibody tail; it soaks up TNF. Injected for rheumatoid, psoriatic and spinal arthritis and psoriasis, not for bowel disease.

Updated 2026-11-01

- Class: [TNF inhibitors](https://durgical.com/en/pharmacology/classes/tnf-inhibitors/)
- Target: Tumour necrosis factor alpha (TNF-α)
- ATC code: L04AB01

◆**Tumour necrosis factor alpha (TNF-α)**Etanercept

ⓘ The figure shows TNF bound to the extracellular part of TNF receptor 2; etanercept is that same receptor part fused to an IgG1 Fc, so it grips TNF the same way.

**Target in 3D:** Tumour necrosis factor alpha (TNF-α). PDB structure 3ALQ (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3ALQ) · Drag to rotate · pinch to zoom

## Mechanism of action

Etanercept is a fusion protein: two copies of the extracellular ligand-binding part of the human p75 TNF receptor (TNFR2) joined to the Fc portion of human IgG1. It acts as a soluble decoy receptor that captures TNF before it reaches cell receptors. Unlike the antibodies, it is not approved for Crohn disease or ulcerative colitis.

- TNFR2 ectodomain fused to an IgG1 Fc
- Acts as a soluble decoy receptor
- Traps TNF-α before it reaches cells
- Joint and skin inflammation falls

## Pharmacokinetics

**Absorption**
Subcutaneous injection; absorbed slowly

**Metabolism**
Broken down like other proteins

## Indications

- Rheumatoid arthritis [Rheumatoid arthritis →](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- Polyarticular juvenile idiopathic arthritis [Juvenile idiopathic arthritis →](https://durgical.com/en/conditions/juvenile-idiopathic-arthritis/)
- Psoriatic arthritis [Psoriatic arthritis →](https://durgical.com/en/conditions/psoriatic-arthritis/)
- Ankylosing spondylitis [Ankylosing spondylitis →](https://durgical.com/en/conditions/ankylosing-spondylitis/)
- Chronic plaque psoriasis [Psoriasis →](https://durgical.com/en/conditions/psoriasis/)

## Adverse effects

### Common

- Injection-site reactions (redness, itching, bruising)
- Upper respiratory infections

### Serious (rare, important)

- Serious infections (bacterial, viral, fungal and opportunistic) that can need hospital care or be fatal
- Reactivation of latent tuberculosis or hepatitis B
- Lymphoma and other cancers, including in children and young adults; hepatosplenic T-cell lymphoma in young people with inflammatory bowel disease
- New or worse heart failure
- Demyelinating disease (multiple sclerosis, optic neuritis, Guillain-Barré syndrome)
- Lupus-like syndrome; low blood counts
- Seizures; low blood counts with bruising or bleeding

## Contraindications

- Active serious infection, including active tuberculosis
- Hypersensitivity to etanercept

## Key interactions

**Anakinra or abatacept**
More serious infections without added benefit; not combined.

**Live vaccines**
Risk of infection by the vaccine strain; avoided during treatment.

**Other immunosuppressants (glucocorticoids, methotrexate, azathioprine)**
Additive risk of infection; azathioprine or mercaptopurine with a TNF blocker has been linked to hepatosplenic T-cell lymphoma.

## What is monitored

- Latent tuberculosis test before starting, and watch for active TB during and after treatment even if the test was negative
- Hepatitis B screening before starting
- Signs of infection at every visit
- Skin checks for cancer

## Administration and safety

- Subcutaneous injection, rotating sites (thigh, abdomen, upper arm).
- Some devices contain latex in the needle cover; latex allergy is asked about.
- Kept refrigerated in its carton.

## Nursing care

- Confirm that the latent TB test and hepatitis B screening are done (and treated if positive) before the first dose.
- Do not give the dose during an active infection; report fever, cough, night sweats or weight loss.
- Check that vaccines are up to date before starting; live vaccines are avoided during treatment.
- Ask about heart failure and neurological disease before starting.
- In people with diabetes, watch blood glucose: other diabetes medicines may need review.

## Pregnancy and breastfeeding

If it is used in pregnancy, the baby's doctor is told, because some vaccines for the infant may need to be given later than usual.

## Memory aid

etanerCEPT = reCEPTor: a TNF receptor decoy. It is used for joints and skin, not for the gut (not approved for Crohn or colitis).

## Test yourself

Think of the answer, then tap the question to see it.

## What is the structure of etanercept?

Two extracellular domains of the p75 TNF receptor (TNFR2) fused to the Fc portion of human IgG1: a soluble decoy receptor.

## Which TNF inhibitor is not approved for inflammatory bowel disease?

Etanercept; infliximab, adalimumab, certolizumab pegol and golimumab have bowel indications.

## What should be checked before the first etanercept dose?

Latent tuberculosis, hepatitis B, active infections, vaccines (no live ones during treatment), and history of heart failure or demyelinating disease.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/etanercept/)

## Related drugs

- [Adalimumab](https://durgical.com/en/pharmacology/adalimumab/)
- [Infliximab](https://durgical.com/en/pharmacology/infliximab/)
- [Certolizumab pegol](https://durgical.com/en/pharmacology/certolizumab-pegol/)
- [Golimumab](https://durgical.com/en/pharmacology/golimumab/)
- [Abatacept](https://durgical.com/en/pharmacology/abatacept/)

## Related conditions

- [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- [Juvenile idiopathic arthritis](https://durgical.com/en/conditions/juvenile-idiopathic-arthritis/)
- [Psoriatic arthritis](https://durgical.com/en/conditions/psoriatic-arthritis/)
- [Ankylosing spondylitis](https://durgical.com/en/conditions/ankylosing-spondylitis/)
- [Psoriasis](https://durgical.com/en/conditions/psoriasis/)

[← Back to the class: TNF inhibitors](https://durgical.com/en/pharmacology/classes/tnf-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Etanercept Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a602013.html) (MedlinePlus (U.S. National Library of Medicine), 2024); [Altered Immunocompetence | Vaccines & Immunizations | CDC](https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html) (Centers for Disease Control and Prevention (CDC), 2024); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 39 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L04AB01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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