Etanercept‐induced subacute cutaneous lupus erythematosus

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Abstract
Sir, Etanercept (Enbrel®) is a human tumour necrosis factor (TNF) receptor p75 Fc fusion protein which is used for the treatment of active rheumatoid arthritis if the response to disease‐modifying anti‐rheumatic drugs has proved insufficient. TNF is the product of macrophages and exerts powerful effects on the immune system, including the induction of proinflammatory mediators (e.g. interleukin‐1, nitric oxide and prostaglandins), metalloproteinases and adhesion molecules [1]. Etanercept acts as a competitive inhibitor of TNF and prevents binding of TNF to the cell surface TNF‐R, thereby reducing the biological activity of TNF [2]. Adverse effects are usually limited to injection‐site reactions and upper respiratory tract reactions [2–5]. Recently, the European Agency for the Evaluation of Medicinal Products issued a statement regarding serious blood dyscrasias associated with etanercept [6]. Formation of antibodies to double‐stranded DNA (dsDNA) has been noted in patients treated with etanercept, but lupus‐like syndrome is not mentioned in the product information. We report on a 54‐yr‐old female who developed subacute cutaneous lupus erythematosus (SCLE) during treatment with etanercept.