Take the Guess Work Out of Biologic Rheumatoid Arthritis Choice

April 9, 2024

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that not only affects the joints but can exert systemic influence, potentially impacting various body systems. The journey through RA treatment is unique for each individual, necessitating a personalized approach. Enter precision medicine for rheumatoid arthritis—the practice of tailoring treatment to the individual characteristics of each patient.

Today we delve deep into how molecular signature testing is revolutionizing treatment decision-making in RA.

Understanding Molecular Signature Testing

Within precision medicine for rheumatoid arthritis, molecular signature testing is emerging as a novel way we can identify whether individuals might benefit from certain biologic medications. The molecular signature is essentially a unique ‘barcode’ of gene expression within an individual’s immune cells. This can predict the body’s response to different treatments.

The Study At Hand: A Pivotal Discovery

Recently, a critical study titled “Patient outcomes improve when a molecular signature test guides treatment decision-making in rheumatoid arthritis,” published in the Expert Review of Molecular Diagnostics, has provided substantial evidence supporting the integration of molecular signature testing in managing RA.

In the study, researchers elucidated the role of a specific test—the Molecular Signature Response Classifier (MSRC). The MSRC is designed to predict whether patients with RA will respond to tumor necrosis factor inhibitor (TNFi) therapies, a common class of biologic drugs used in treatment. These medications include Enbrel, Humira, Cimzia, Simponi, and Remicade as well as their biosimilar equivalents.

Unlocking Personalized Treatment Strategies

Biologic medications, which target specific components of the immune system, have transformed the landscape of RA treatment. However, the response to these drugs can vary significantly among patients—a challenge that precision medicine for rheumatoid arthritis seeks to address.

The Molecular Signature Response Classifier (MSRC) test functions as a sophisticated investigative tool employed to decipher the intricate workings of your immune system, particularly in relation to rheumatoid arthritis (RA). At its core, the MSRC examines the patterns of gene expression, which can be envisioned as the “on” or “off” switches of genes within your immune cells. These patterns can provide crucial insights into your body’s unique response to specific medications, specifically tumor necrosis factor inhibitors (TNFis)—a class of biologic drugs frequently utilized in RA treatment.

By measuring these gene expressions, the MSRC can predict with a remarkable degree of accuracy whether your body is likely to respond favorably to TNFis, thus avoiding the potential trial and error associated with medication effectiveness. This personalized approach not only guides your healthcare provider in selecting the most appropriate treatment for your condition but also reflects a conscientious and empathetic stride towards optimizing your healthcare experience, minimizing unnecessary interventions and focusing on treatments that align with your body’s individual genetic makeup.

The study showcases how MSRC testing can predict the efficacy of TNFi medications for individuals with RA. This innovative approach posits that using a patient’s molecular signature could improve rates of remission and help in selecting the most fitting biologic therapy.

Simply put, it seeks to take the guess work out of biologic therapy choice.

The Research Outcomes: A Patient-Centric View

Improving Patient Journeys

By analyzing a pooled cohort of patients who were subjected to MSRC testing to guide biologic therapy selections, the study demonstrated a significant improvement in patient outcomes, notably in remission rates and achieving low disease activity. Specifically, patients in the MSRC-tested arm achieved higher proportions of clinical disease activity index (CDAI) low disease activity or remission (CDAI-LDA/REM) and remission alone (CDAI-REM), compared to those in the external control group, over a six-month period. Furthermore, a notable improvement was observed in minimally important differences (MID) in CDAI scores, indicating a meaningful reduction in disease activity from baseline.

The Promise of Precision Medicine in Action

Each RA patient’s battle is distinct, often filled with trials and adjustments in treatment regimens. The clear message from this research is that precision medicine for rheumatoid arthritis, epitomized by molecular signature testing, can facilitate a more targeted treatment approach—a leap forward from the one-size-fits-all strategy.

What This Means for You: Precision Medicine’s Role

Contemplating Biologic Treatment Options

If you are considering initiating biologic therapy or are reevaluating your current regimen, precision medicine for rheumatoid arthritis offers a scientific beacon. By assessing your unique molecular signature, clinicians can better forecast which therapy aligns with your body’s intrinsic biology.

Precision Medicine for Rheumatoid in Clinical Practice

The clinical implications are considerable. The integration of molecular testing in treatment planning could not only enhance patient outcomes but potentially streamline the therapeutic trajectory, reducing the trial-and-error approach that many patients and their doctors face.

Collecting the Pieces: The Broader Implications

Beyond Individual Outcomes

Precision medicine’s implications extend beyond individual patient care not only for rheumatoid arthritis but also other autoimmune conditions such as multiple sclerosis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, etc. This paradigm has the potential to enhance healthcare resource utilization by optimizing medication selection and reducing the economic burden of ineffective treatments.

Concluding Thoughts: The Precision Medicine Landscape

As we navigate the intricate landscape of RA, molecular signature testing stands as a promising lighthouse, guiding us towards safe harbors of effective treatment options. By embracing the tailored approach that precision medicine for rheumatoid arthritis offers, we can look forward to a future where patients are not only treated but understood on a molecular level.

Call to Action: Partner with Precision

If you are at a crossroads in your RA treatment journey, consider discussing molecular signature testing with your healthcare provider. It is a step towards a personalized treatment plan crafted with your unique genetic makeup in mind, offering the potential for improved outcomes and quality of life.

References

Molecular Signature Testing: PrismRA

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advise you to speak with your medical professional if you have questions concerning your symptoms, diagnosis, and treatment.

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Diseases and Conditions Self-Injection Videos

How to Inject Orencia at Home

April 2, 2024

Orencia, also called abatacept, is a biologic medication prescribed for rheumatoid arthritis and now, psoriatic arthritis. It comes both as an autoinjector/pen or as a prefilled syringe. In previous posts we covered how to inject Humira, Enbrel, Simponi, and Cimzia as well as how to inject methotrexate. In this week’s post, we’ll learn how to inject Orencia at Home.

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the autoinjector or prefilled syringe out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Chose an area to inject – Thigh or Stomach.
- Chose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

Injecting Orencia with an autoinjector/pen

Observe the medication in the window to be sure that it is clear (no cloudiness or crystals)
- You will see a small air bubble within the window, this is normal and will not cause harm when injecting
Remove the cap
Press the tip of the auto-injector down in the skin at a 90 degree angle until it is flush with the skin
Press button and hold for 15 seconds
Viewing window will turn yellow or blue, but continue to hold the button for the full 15 seconds
Lift the auto-injector straight up

Injecting Orencia with a prefilled syringe

Pull off the cap and observe the syringe to be sure that it is clear (no cloudiness or crystals)
Pinch the skin around the injection site and enter at a 45-degree angle
Press the plunger (slowly) to administer the medication
Once the medication is fully administered, the plunger will reach the bottom and a spring will place a cover over the needle

After the injection

Properly dispose of the entire autoinjector/pen or prefilled syringe
- Sharps Container
  - Can be purchased at your local pharmacy
  - Disposal
- - Hospitals and nursing homes may take full sharps containers, ask first.
  - Pharmacies and Doctors’ offices are not allowed to take used syringes or needles
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

For more information regarding Orencia, please follow this link.

Medical Disclaimer

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Journal Club

Proven Benefits of a Plant-Based Diet for Rheumatoid Arthritis Relief

March 19, 2024

Can a plant-based diet help relieve rheumatoid arthritis symptoms?

Rheumatoid arthritis (RA) is an autoimmune condition characterized by chronic inflammation of the joints, leading to progressive tissue damage, pain, stiffness, and decreased mobility. In the quest to find more holistic approaches to manage this debilitating condition, recent scientific research has turned attention to dietary interventions, particularly the role of plant-based diets.

A pivotal study, often referred to as “Plants for Joints” (PFJ), has shed new light on this area, providing noteworthy insights into how incorporating plants in the diet could potentially alleviate the symptoms of rheumatoid arthritis.

Understanding the Study Framework

In the meticulously structured ‘Plants for Joints’ (PFJ) study, participants who were randomized to the intervention group embarked on a carefully tailored, multidisciplinary program targeting their rheumatoid arthritis. The initiation of their journey involved individualized consultations with a dietitian and a physical therapist, designed to design the intervention to their specific needs. Over the course of the program, these individuals participated in 10 group sessions that lasted between 2 to 3 hours each, fostering a supportive community environment in which peer education and support were actively encouraged.

Out of the cohort, 17 individuals experienced the entirety of the program through in-person sessions, while another 23 navigated a hybrid model—owing to COVID-19 precautions—with a mix of 2 to 4 live and additional virtual sessions. At the heart of the program was a comprehensive educational component that covered theoretical and practical aspects of a whole-food, plant-based diet, consistent with the 2015 Guidelines on Healthy Nutrition from the Health Council of the Netherlands. Furthermore, participants were guided to establish achievable physical activity targets, aligning with the 2017 Dutch Physical Activity Guidelines, which advocate for 150 minutes of moderate-intensity activity weekly, supplemented by twice-weekly muscle and bone-strengthening exercises.

Addressing Lifestyle with Rheumatoid Arthritis

To address the components of lifestyle influencing rheumatoid arthritis, psychoeducation was provided to elucidate the impact of stress on health, coupled with stress management strategies. Sleep optimization was also a component of the intervention, recognizing its vital role in health and wellbeing. Participants had access to resources including general information, instructional videos, and exercises that could be performed at home. Nourishment for the program was not just theoretical—participants were equipped with a meticulously planned weekly menu, bolstered by daily supplements of the active form of vitamin B12 (1500 mg) and the active form of vitamin D (50 µg) to ensure intake of crucial nutrients commonly deficient in a plant-based diet, such as protein, omega-3 fatty acids, iron, zinc, iodine, and calcium.

In contrast, the control group received standard medical care without any alterations to their existing dietary or lifestyle regimen, thus establishing a baseline against which the intervention’s efficacy could be measured.

Scientific Outcomes of the Intervention

The findings from the PFJ study were both encouraging and scientifically significant. Participants who adhered to the plant-based diet showed a remarkable decrease in RA disease activity, as determined by both subjective measures (such as patient global assessment and tender joint count) and objective measures (including swollen joint count, body composition, and an assortment of metabolic markers).

These improvements suggest a noteworthy improvement of symptomatic expression of RA, potentially attributed to the anti-inflammatory and immunomodulatory effects of the diet.

Furthermore, the holistic nature of the intervention, incorporating physical activity and stress management, underscores the multifaceted approach required in managing rheumatoid arthritis effectively. This aligns with current understanding that RA management should extend beyond pharmacological treatments to include lifestyle modifications to maximize patient outcomes.

Critical Analysis of the Study’s Limitations

While the outcomes of the PFJ study are indeed promising, it is imperative to approach these findings with a critical lens, especially considering the study’s limitations. The sample size was relatively small, and the intervention period lasted only 16 weeks, raising questions about the long-term sustainability and effectiveness of such dietary changes in RA management. Additionally, because the study intentionally combined multiple lifestyle factors, discerning the individual contribution of the plant-based diet versus other interventions (physical activity, stress reduction) to the observed health benefits becomes challenging.

It is also noteworthy that the study reported improvements in both subjective and objective measures of disease activity. However, the degree to which extra attention provided to the intervention group (participant observation bias) influenced these outcomes cannot be entirely dismissed.

Moving Forward: Implications for Clinical Practice and Research

The PFJ study provides a compelling foundation for the potential role of plant-based diets in managing rheumatoid arthritis. Nonetheless, further research with larger randomized controlled trials is essential to fully understand the long-term effects and practicality of implementing such dietary changes. Investigations exploring the specific components of plant-based diets that are most beneficial for RA patients, as well as studies assessing the efficacy of these diets in different RA phenotypes, are needed.

Conclusion

In conclusion, the “Plants for Joints” study provides insightful evidence into the positive impact of plant-based diets on rheumatoid arthritis management. While promising, the complexities of RA and the limitations of the current study necessitate cautious interpretation and further investigation. For individuals living with rheumatoid arthritis, considering dietary changes as part of a comprehensive management strategy could offer additional pathways to alleviate symptoms and improve quality of life. Nonetheless, such decisions should always be made in consultation with healthcare professionals, ensuring a tailored approach that meets each individual’s unique health needs.

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Self-Injection Videos

How to Inject Hyrimoz at Home: A User-Friendly Guide

March 12, 2024

Injecting medication at home can seem daunting, but it doesn’t have to be. If your doctor has prescribed Hyrimoz for your condition, such as rheumatoid arthritis, psoriasis, uveitis or Crohn’s disease, this comprehensive guide on how to inject Hyrimoz at home will walk you through every step with clarity and confidence.

What is Hyrimoz?

Hyrimoz® (adalimumab-adaz), which you may be preparing to administer, is not just a standard therapeutic agent; it is, in fact, a biosimilar medication. As a biosimilar, it is highly similar to an existing biological medication, known as the ‘reference product’, which in this case is adalimumab, marketed under the brand name Humira®. Extensive comparison through analytical studies has shown that Hyrimoz matches its reference in terms of potency, safety, and efficacy.

Despite the similarities, it is important to note that biosimilars are not labeled as “generic” versions of biologic medications because biologics are derived from living cells and are inherently complex, and it is impossible to create an exact copy. Rest assured, before approval, Hyrimoz has gone through rigorous regulatory pathways to confirm that it is as safe and efficacious as the original biologic.

Preparing for Your First Self-Injection

Excited? Maybe a little nervous? Totally normal feelings when you’re about to take charge of your health in a hands-on way.

How to Inject Hyrimoz at Home – Starting Steps

Clean Workspace: First thing’s first—find yourself a clean, well-lit area to prepare.
Hand Hygiene: Wash your hands with soap and water. It’s simple, but it’s one of the most effective ways to prevent infection.
Gather Supplies: Get your Hyrimoz pre-filled syringe or pen, alcohol wipes, cotton balls, and a sharps container for disposal.
Storage Savvy: Remember, Hyrimoz should be stored in the refrigerator. If it’s too cold to the touch, let it sit out for 30 minutes to reach room temperature. Never use a microwave or hot water to warm it.

Step-by-Step Injection Guide

Here’s the meat and potatoes of what you came for—how to inject Hyrimoz at home:

Check It: Inspect your Hyrimoz. It should be clear, and colorless to slightly yellow. If it’s cloudy or has particles, don’t use it.
Skin Selection: Choose your injection spot—either the front of your thighs or your belly, avoiding the waistline and staying two inches clear of the navel.
Clean Up: Swipe the selected area with an alcohol wipe and let it air dry.
Get Grip-Ready: Hold the pen firmly. Remove the needle cover when you’re set to go.
Pinch an Inch: With your free hand, gently pinch the skin around the injection site.
Needle in, Steady: Press the pen firmed onto your pinched skin at 90-degree angle.
Plunge with Confidence: Press the plunger down and steadily until all the medication is injected. It typically take 10 to 15 seconds.
Release and Withdraw: Let go of your skin. Pull the needle out while keeping it at the same angle it went in.
Praise and Press: Give yourself a little internal high-five for a job well done. Place a cotton ball over the site and apply pressure for a bit. If there’s bleeding, that’s okay. Just keep the pressure on a little longer.
Sensible Disposal: Don’t recap the needle. Pop it straight into the sharps container. Of note, Hyrimoz does have a free sharp container delivery service to your home as well as free returns.

Doesn’t sound too tricky, right? Remember, practice makes perfect.

Common Concerns

Feeling some nerves approach as the injection day circles on your calendar? It’s totally okay.

What About Side Effects?

Hyrimoz, like any medication, can come with side effects, including:

Injection site reactions
Upper respiratory infections
Headaches
Rash

For a complete list, always refer to the medication guide provided with your prescription as well as your doctor.

Tips and Tricks for Successful Home Injections

Consistency is Key: Stick to a routine. Consistent timing can help make self-injections second nature.
Record Keeping: Keep a diary of your injection sites. This helps in rotating sites and tracking your condition.
Support System: Get your family or friends involved. A support system can offer a helping hand or emotional backing.

In Conclusion: Empower Yourself

Learning how to inject Hyrimoz at home is a commitment to your well-being and health autonomy. Even though administering your injection might feel overwhelming at first, with each little push of the plunger, you’ll become more adept and confident in your ability to manage your treatment.

Call to Action: Take the First Step

Every journey begins with a single step — your health journey is no different. If you’ve been prescribed Hyrimoz, start by discussing your treatment plan in-depth with your healthcare provider. Once you’re ready, gather your courage (and your supplies!) and take charge of your health, one injection at a time.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis, and treatment.

Patient Advocacy

The Methotrexate Shortage – What Can We Do Now?

January 30, 2024

Introduction

Although other newer biologics are available, methotrexate remains a cornerstone treatment for rheumatoid arthritis today.

When the Shortage Began

The current shortage of methotrexate began in late 2022, according to the American Society of Health-Systems Pharmacists (ASHP). It was primarily caused by manufacturing delays and supply chain issues impacting several major methotrexate suppliers, including Pfizer, Teva, and Fresenius Kabi. This led to intermittent supply disruptions and backorders for both the injectable and oral forms of the drug.

The methotrexate shortage has been further exacerbated by increased demand for the drug during the COVID-19 pandemic. Rheumatoid arthritis patients have been seeking additional prescriptions to manage worsening pain and inflammation while staying home. This spike in demand made the limited supply even more scarce for those dependent on methotrexate.

Expected Duration of the Methotrexate Shortage

The exact end date of the methotrexate shortage is still unclear. Manufacturers have indicated the shortage could potentially last through much of 2023, depending on how quickly they can resolve the underlying manufacturing and supply issues.

According to the American Society of Health-System Pharmacists (ASHP), the shortage is expected to continue through at least June 2023 for injection formulations from suppliers like Fresenius Kabi and Hikma [1]. The timeline is less certain for oral formulations, with some manufacturers like Teva unable to provide estimates on resolution.

Ultimately, the duration of the methotrexate shortage is highly dependent on pharmaceutical companies bringing their manufacturing capabilities back to normal levels. Some progress is being made, with Accord Healthcare restarting production in late 2022 after facility issues [2]. However, until all manufacturers have fully resumed stable methotrexate production and replenished inventory, the shortage is likely to persist.

Impacts on Rheumatology Patients

The methotrexate shortage has had significant impacts on rheumatology patients who rely on the drug to manage their conditions. Many patients are reporting difficulty filling their methotrexate prescriptions as pharmacies face short supply. This forces some patients to skip doses or take smaller doses than prescribed, which can lead to increased joint pain, stiffness, and swelling as their condition flares up. One survey found that 76% of pediatric cancer centers had patients miss or delay methotrexate doses due to the shortage.

In some cases, rheumatology patients may be forced to switch to more expensive biologic drugs instead of methotrexate to manage their symptoms. However, these drugs can cost thousands of dollars per dose, resulting in much higher out-of-pocket medical expenses. The financial strain adds further hardship for patients already dealing with increased joint inflammation and pain from the lack of methotrexate.

Alternatives During the Shortage

With the methotrexate shortage, rheumatology patients and their doctors need to explore alternatives to manage symptoms. Some options include:

Other DMARDs (disease-modifying antirheumatic drugs) like sulfasalazine or leflunomide may be substituted, depending on the patient’s condition. These work in a similar way to methotrexate and can help control inflammatory arthritis.

Biologics like Humira (adalimumab) or Enbrel (etanercept) target specific parts of the immune system. They can be very effective for rheumatoid arthritis but are more expensive.

Corticosteroids like prednisone reduce inflammation and pain quickly. But long-term use can cause side effects, so they are typically used as a bridge until other treatments start working.

Lifestyle measures like rest, exercise, diet, and stress management may also help patients manage symptoms during the shortage. But they should not replace disease-modifying medications.

Ultimately, it is important to have a conversation with your physician to discuss your personalized treatment plan.

Efforts to Resolve the Methotrexate Shortage

There are ongoing efforts to improve the methotrexate supply and end the shortage as soon as possible. Major manufacturers like Teva and Mylan have been working to resolve the issues that led to the shortage at their facilities (source). Teva restarted production at one facility in November 2022, which has helped stabilize the supply somewhat.

The FDA has also worked to increase available supply by reaching agreements to import methotrexate from abroad. The regulatory agency is engaging with manufacturers around the world to facilitate greater imports to meet US demand (source).

In addition, the FDA has allowed compounding pharmacies to help close the gap by producing compounded methotrexate products. While compounded drugs carry greater risk, this temporary measure expands supply while issues limiting manufacturing persist.

Preparing for Future Shortages

To prevent shortages in the future, steps must be taken to improve the resilience of the pharmaceutical supply chain. According to the AMA, diversifying suppliers is key to avoiding disruptions when a single company faces manufacturing issues (AMA, 2023). The FDA also recommends increasing stockpiles and reserves of essential medications that are at risk of shortage (Shuman, 2020). Finally, end-to-end supply chain transparency and information sharing between manufacturers, wholesalers, pharmacies, and regulators can identify potential shortages earlier and mobilize responses (Pharma News Intel, 2023).

By taking a proactive, collaborative approach, the pharmaceutical industry can build a more resilient supply chain and ensure patients have access to vital medications during public health emergencies. Regulators must also be empowered to act quickly when shortages arise to minimize disruptions to patient care.

Conclusion

In summary, the methotrexate shortage that began in late 2022 has had significant impacts on rheumatology patients who rely on this critical medication. Patients have struggled to access their usual methotrexate doses, resulting in increased symptoms and reduced quality of life. Rheumatologists have worked hard to find alternatives, but options are limited. This highlights the importance of ensuring consistent supply and production of key medications.

Solutions require collaboration across the pharmaceutical industry and government regulators. Manufacturing and supply chain improvements are needed to prevent future shortages and ensure access. With luck this shortage will be resolved quickly, but work remains to build a more resilient prescription drug supply system.

There is hope the manufacturers will resolve the issues causing this shortage in the coming months. However, the impacts have shown the vulnerability of relying on just a few suppliers for essential medications. Rheumatology patients and providers will continue advocating for reliable access to the treatments they need.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis

Self-Injection Videos

Enbrel SureClick: What to Know About Taking the Autoinjector Pen

December 27, 2023

What is Enbrel?

Enbrel is a prescription biologic medication used to treat certain autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, and plaque psoriasis. It comes as an autoinjector called Enbrel Sureclick, a syringe, and delivered with a machine (i.e., Enbrel Mini).

It contains the active ingredient etanercept, which is a tumor necrosis factor (TNF) blocker that targets overactive immune system cells to reduce inflammation and manage disease symptoms. Enbrel works by binding to TNF and blocking its function, which interrupts the inflammatory cascade that leads to joint swelling, pain, and damage in inflammatory forms of arthritis.

Enbrel comes in an autoinjector pen called the Enbrel SureClick that allows patients to self-administer the medication subcutaneously. The autoinjector contains a pre-filled cartridge with a single dose of Enbrel and spring-activated needle for injection. Using the autoinjector allows for a simple, convenient way to take the medication at home.

Understanding the Enbrel SureClick Autoinjector

The Enbrel SureClick autoinjector is a prefilled, single-dose disposable device designed to make self-injection straightforward and convenient. Here are the main parts to understand:

Cap – Covers the needle before injection to keep it sterile. Remove the cap just before injecting.
Viewing window – Allows you to see the Enbrel solution inside the device. Make sure the liquid looks clear to slightly yellowish and does not contain particles.
Expiration date – Check that the date has not passed before using. Do not use if expired.
Medicine – Each SureClick contains 50 mg of Enbrel in a prefilled syringe. No reconstitution is required.
Needle guard – Covers the needle after injection to prevent injury. The needle guard will deploy and lock automatically after the full dose is given.
Start button – Pressing this blue button starts the injection after the autoinjector is positioned on skin.
Injection complete indicator – Orange part that is visible when injection is done.

Familiarize yourself with these parts before using the Enbrel SureClick to ensure proper administration. With some preparation and by following all instructions, the autoinjector allows you to easily and comfortably deliver your Enbrel dose subcutaneously.

Before the Injection

Before injecting Enbrel, take the autoinjector out of the refrigerator and allow it to reach room temperature. This is an important step, as injecting cold medication can be uncomfortable. Leaving Enbrel at room temperature for about 30 minutes before injection allows the medication to warm up.

Some tips for allowing Enbrel to reach room temperature:

Take Enbrel out of the refrigerator about 30 minutes before your scheduled injection time.
Do not try to warm the medication by heating it in a microwave or placing it in hot water, as this can damage the medication.
Lay the autoinjector on a flat surface like a tabletop or counter while you wait for it to warm up.
Avoid leaving Enbrel out of the refrigerator for longer than 30 minutes before injecting. The medication can be safely kept at room temperature for up to 30 days if needed, but it’s best to inject it as soon as it reaches room temperature. You also should not put it back in the refrigerator.
Check the solution in the autoinjector window periodically. When ready to inject, the solution should be clear and colorless, with no lumps or particles.

Allowing Enbrel to warm to room temperature helps make the injection process smooth and comfortable. Once the medication has reached room temperature, you are ready for the next steps of preparing the injection site and injecting Enbrel.

Choosing the Injection Site

The recommended injection sites for Enbrel SureClick are the abdomen, thighs, and upper arms. These areas generally have more padding between the skin and muscle which makes injections easier and more comfortable.

When choosing a site, avoid injecting within 2 inches of the navel or any scar tissue or bruises. Also avoid areas that are tender, red, hard or have psoriasis plaques.

Rotate injection sites with each use. Do not inject into the exact same spot each time. Recommended rotation patterns include:

Abdomen: Divide the abdomen into quadrants using the navel as the center. Inject in a different quadrant each time.
Thighs: Alternate between left and right thigh.
Upper arms: Alternate between left and right upper arm.

Properly rotating sites allows one area to fully heal between injections. This helps minimize skin reactions or buildup of scar tissue.

Preparing the Injection Site

Before administering your Enbrel injection, you will need to properly prepare the injection site. This helps ensure the medication is delivered safely and effectively.

The first step in preparing the injection site is to wash your hands thoroughly with soap and warm water. Be sure to scrub for at least 20 seconds. This helps remove dirt and bacteria from your hands before handling the injection components.

Once your hands are clean, use an alcohol wipe to clean the skin at the injection site you have chosen. Be sure to let the alcohol fully dry before proceeding. Cleaning the skin with an alcohol wipe kills bacteria on the surface of the skin and prevents infection.

Only inject Enbrel into areas with no signs of skin problems like redness, swelling, scarring, or irritation. Avoid injecting into areas that are bruised, scarred, or feel hard. Also do not inject into moles, scars, bruises, or areas where the skin is tender, damaged, red, or hard.

Properly cleaning the injection site with an alcohol wipe before each use of Enbrel helps minimize skin reactions and ensure proper delivery of the medication.

Removing the Cap

To remove the cap from the Enbrel SureClick autoinjector, first inspect the cap to make sure it is intact and has not been previously removed. Grasp the cap and gently pull it straight off the autoinjector. Do not twist or bend the cap, as this could damage the internal needle.

Once you have removed the cap, set it aside on a clean surface. Be careful not to touch the exposed needle under the cap with your fingers, as this could contaminate the needle. The autoinjector is now ready for positioning and injection. Avoid removing the cap until you are ready to inject, as this helps keep the needle sterile.

If the cap is loose, damaged, or missing, do not use that autoinjector. Call your healthcare provider for a replacement. Never try to recap a used autoinjector or you may risk accidental needlestick injury.

Positioning the Autoinjector

Hold the autoinjector at a 90 degree angle against the injection site you have cleaned. You want to position it straight up and down, perpendicular to the skin, not at an angle. This allows the needle to properly insert into the skin.

Gently press the autoinjector firmly against the skin to start the injection. You will hear a click which signals the start of the injection, but continue holding it firmly in place. It is important to keep holding it securely against the skin throughout the entire injection process.

Do not try to inject at an angle as this can affect how well the medication is delivered. Keep the autoinjector straight up and down. Apply enough pressure so that it remains firmly in contact with the skin.

Starting the Injection

Once you have positioned the autoinjector against your skin at the injection site, you are ready to start the injection. To do this, you simply need to:

Firmly push the autoinjector all the way down against your skin until it stops moving. This will trigger the start button.
Listen for the click. The click signals that the injection has started and the medicine is being delivered.
Keep pushing down on the autoinjector. It is important to hold the autoinjector in place against your skin after the click for about 10 seconds to allow the full dose to be delivered.
You may hear a second click during this time – this is just an indicator that the injection is nearly complete.
After 10 seconds, you can then lift the autoinjector straight off of the injection site. The purple indicator will be visible to confirm the dose has been fully given.

Pushing the autoinjector all the way down until it stops moving is the action that starts the injection process. Keep the autoinjector firmly in place for 10 seconds after the click to allow the full dose to be properly injected.

Completing the Injection

After the loud click, continue holding the Enbrel SureClick autoinjector firmly against your skin for 10 seconds to ensure the full dose is delivered. Do not remove it sooner than 10 seconds, even if you think the injection is complete.

Holding the device in place allows time for all of the medication to be injected under the skin. If you remove it too soon, some medication may stay in the autoinjector and you will not get your full dose.

Keep holding the autoinjector firmly against the injection site for a slow count of 10 seconds. Count slowly in your head or out loud. After counting to 10, you can then lift the autoinjector straight up from your skin to complete the injection.

The blue indicator will now be visible to confirm the injection is complete. You may see a few drops of liquid on your skin, which is normal. Press a cotton ball or gauze pad over the injection site and hold for 10 seconds. Do not rub the site.

After the Injection

After you have completed the injection, you can remove the autoinjector from your skin. Check the viewing window to ensure the purple indicator is visible, confirming the full dose has been delivered. There may be a small amount of blood at the injection site – you can press a cotton ball or gauze over the injection site for 10 seconds to stop any bleeding. Do not rub the injection site.

It is important to properly dispose of the used autoinjector right away. Place the used SureClick autoinjector into an FDA-cleared sharps disposal container right away after use. Do not throw away (dispose of) loose needles and syringes in your household trash. Do not recycle your used sharps disposal container.

If you do not have an FDA-cleared sharps disposal container, you may use a household container that is:

Made of a heavy-duty plastic
Can be closed with a tight-fitting, puncture-resistant lid, without sharps being able to come out
Upright and stable during use
Leak-resistant
Properly labeled to warn of hazardous waste inside the container

When your sharps disposal container is almost full, follow your community guidelines for the right way to dispose of your sharps disposal container. There may be state or local laws about how to throw away used needles and syringes.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

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