Etanercept Injection for Stroke: Is This High-Cost, Experimental Treatment Worth It?

The Etanercept injection for stroke patients is causing controversy. The success stories seem promising – but the non-randomized controlled clinical trials could be biased, and the American Academy of Neurology issued a contested warning in 2016.

If you’re considering this costly treatment, it’s important to know the facts before making a decision. We hope to provide some clarity when evaluating Etanercept injection for stroke.

What Is Etanercept?

Etanercept (Enbrel) is a tumor necrosis factor inhibitor that alters your body’s inflammation response. Tumor necrosis factor (TNF) encourages inflammation in the body, which is needed to fight disease and infection.

Etanercept prevents inflammation and immune responses induced by TNF. It is intended to fight inflammation in people with autoimmune diseases, where inflammation is known to cause problems. Etanercept is approved to treat autoimmune diseases like rheumatoid arthritis and psoriasis.

The use of Etanercept injection for stroke is experimental. Studies are evaluating its use for pain management after stroke, and some have demonstrated improved functions.

Using Etanercept with Stroke Patients

While stroke is not an autoimmune disease, researchers are exploring whether TNF inhibitors can help post-stroke disability by reducing inflammation in the brain. This is interesting because it’s theorized that stroke may lead to a persistent neuroinflammatory response in the brain.

Researchers are questioning whether Etanercept injection for stroke can help reduce that inflammation. It is expected that the reduction in inflammation may have an effect on post-stroke disability. For the treatment of stroke, Etanercept is injected into the spine (perispinal etanercept) and the patient is tipped backward to encourage the drug to enter the brain.

There have been eye-witness reports of a single dose of perispinal Etanercept producing an immediate improvement in expressive aphasia, speech apraxia, cognitive function, and left hemiparesis. In a non-randomized study in 2010 of 617 patients, more than 80% of participants saw a reduction in spasticity and more than 85% saw improved movement.

These overwhelmingly positive results could be biased. They have not been reproduced.  However, Dr. Stephen Ralph from Griffith University in Australia has published some promising results with decreased pain and improved shoulder range of motion after administration of Etanercept. Other Studies seem to trend towards Etanercept injections for Stroke to address pain only.

High Costs of Etanercept in Stroke Rehabilitation

It was once reported that a patient paid $4,800 out-of-pocket for a single treatment of Etanercept and a follow-up visit. The only person currently offering – and therefore profiting – from Etanercept for stroke recovery is Dr. Edward Tobinik. Dr. Tobinik was involved in clinical trials (one in 2011 and 2012) conducted on Etanercept for stroke.

In 2016, the American Academy of Neurology (AAN) issued a warning against the use of Etanercept injection for stroke.  However, research is ongoing to find best practices.

AAN Issues Advisory for Etanercept in Post-Stroke Disability

American Academy of Neurology (AAN) published a practice advisory in 2016 on the use of etanercept for stroke recovery. The AAN stated that there was insufficient evidence to determine the effectiveness of etanercept for post-stroke disability. It also cited that the treatment may be associated with adverse outcomes and high costs.

The AAN stated that the cost of a 25-mg vial of Etanercept is about $440 – which does not include the extra cost of pretreatment evaluation, administration, and follow-up.

The AAN also stated:

“Serious adverse events are described in studies of patients receiving etanercept for other conditions. Such events include injection site reactions, reactivation of tuberculosis, reactivation of hepatitis B virus infection, congestive heart failure, demyelinating neurologic disorders, vasculitis, and hematologic disorders such as aplastic anemia and pancytopenia.”

Considering the Risk of Etanercept for Use in Stroke

While some side effects of Etanercept can be serious, it’s not clear if these side effects are likely at the low dosage used for stroke patients. In fact, the AAN’s practice advisory was criticized in an editorial by Ian Clark, who reprimanded the AAN for overstating the potential side effects of Etanercept for stroke patients.

However, with perispinal Etanercept treatment in the early stages of development, it’s wise to be cautious and vigilant when deciding on treatment. Further randomized, controlled clinical trials are needed to prove the efficacy of Etanercept for post-stroke disability.

What to Look for In Stroke Recovery Treatment

While the jury is still out on the efficacy of Etanercept for stroke recovery, neurologists can probably agree on one thing:

Neuroplasticity is at the core of reliable stroke recovery treatments. Neuroplasticity is the mechanism that your brain uses to heal itself after a stroke by forming new neural connections. This rewiring happens with repetitive stimulus (or “massed practice”), which helps your brain understand what neural connections need building or strengthening.

Your brain likes to be efficient. Whatever you repeatedly practice is what your brain will attempt to get better at.

For example, high repetition of any particular movement stimulates the brain to rewire itself and improve movement. This requires effort – much more work than a single injection of Etanercept – but there is a proven track record of effectiveness.

Instead of getting seduced by expensive stroke treatments that promise overnight results, consider opting for the proven route.