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Enbrel (etanercept) is a new pharmaceutical product that was introduced for the treatment of rheumatoid arthritis. Its major mode of action is to suppress TNF-alpha, a TH-1 embryotoxic cytokine produced by activated natural killer cells (NKa). Recent studies suggest that Enbrel, while blocking TNF-alpha release, may also deactivate NKa cells. If this indeed proves to be correct, then it is quite possible that Enbrel would replace IVIg for the treatment of IVF patients with NK cell activation. In the process, it may dramatically reduce the cost of immunotherapy and eliminate concerns regarding possible viral transmission with IVIg administration. There is currently no evidence that the use of Enbrel produces birth defects. Nevertheless, caution demands that it be withheld during the first trimester of pregnancy. When Enbrel is used to deactivate NK cells in patients undergoing IVF, it should be administered twice weekly by way of 25 mg intramuscular injections that commence four weeks prior to the initiation of ovarian stimulation with gonadotropins. This should continue until the performance of a blood pregnancy tests, whereupon in the event of a positive Beta HCG result, it should be replaced with IVIg therapy. Reports of adverse reactions associated with the use of Enbrel in the treatment of patients with rheumatoid arthritis are rare and are likely to be even more rare when used by IVF patients who by and large are both younger and healthier. Possible adverse reactions may include local infection at the injection site, kidney, bone, and respiratory tract infections, and diarrhea.
www.goivf.com/glossary.php4
Enbrel (Etanercept)
Enbrel is a Cox 2 anti-inflammatory medication developed for patients who have severe rheumatoid arthritis. It was approved by the Federal Drug Administration (FDA) for use in these patients in November of 1998. Enbrel's function is to bind with tumor necrosis factor (TNF) which is secreted by active natural killer cells. Patients with rheumatoid arthritis have been found to have elevated levels of TNF in their joints. Enbrel binds to the TNF, rendering it biologically inactive, resulting in significant reduction of inflammatory activity. Enbrel is used with reproductive immunology patients where there is elevated natural killer activity, both peripherally and in the endometrial tissue. TNF produced by the natural killer cells in the uterus damages the DNA of blood vessels in the endometrium creating stromal hemorrhages which may decrease blood supply to the implanting embryo. The TNF also damages the DNA of the embryo and it may fail to grow, divide, and implant.
Enbrel is administered by subcutaneous injection in the thigh, stomach, or back of the upper arm. It is given every 3½ to 4 days and is packaged four doses in a box which provides a two-week supply. Each dose includes a syringe, one vial of Enbrel, one plunger and two alcohol swabs. The drug should be refrigerated and the manufacturer, Immunex Corporation, provides a toll free information service at 1-888-4Enbrel (1-888-436-2735) to answer any questions consumers may have. Enbrel is administered 30 days, stopping when stimulation medications are started. Occasionally, difficult cases may require more. The FDA classifies drugs into five categories in respect to pregnancy with Category A being deemed the safest. Enbrel has been classified as Category B and there have been studies in animals at doses 60-100 times higher than human doses that have revealed no evidence of harm to the fetus. At this time there are no formal studies with pregnant women. Current data suggest that the use of Enbrel does not reduce the body's ability to fight cancer and also Enbrel should not increase a woman's susceptibility to catch colds or viruses.
www.americanfertility.com/pdfs/miscarriages.p...
www.jrheum.com/subscribers/03/09/1897.html
