Etanercept Injection for Stroke: Is This High-Cost, Experimential 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 has even issued a warning.

If you’re considering this costly treatment, it’s important to know the facts before making a decision.

Here’s everything you need to know about Etanercept injections for stroke recovery.

What Is Etanercept?

Etanercept (Enbrel) is a drug that’s 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 interferes with TNF to discourage the body from producing this inflammatory response.

Etanercept is intended to fight inflammation in people with autoimmune diseases where inflammation is known to cause problems.

Right now, Etanercept is used to treat autoimmune diseases like rheumatoid arthritis and psoriasis.

Stroke is not mentioned in any of the literature on Etanercept. This shows that Etanercept is not conventionally used in stroke recovery.

So why are we starting now?

Using Etanercept with Stroke Patients

Fda research on use of etanercept for 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.

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Researchers are questioning whether or not Etanercept can help reduce that inflammation – and if that will have any effect on post-stroke disability.

For the treatment of stroke, Etanercept is injected into the spine (perispinal etanercept) and the patient is tipped backwards to encourage the drug to enter the brain.

There have been eye-witness reports of a single dose of perispinal Etanercept producing an immediately improvement in expressive aphasia, speech apraxia, cognitive function, and left hemiparesis.

In a non-randomized study of 617 patients, more than 80% of participants saw a reduction in spasticity and more than 85% saw improved movement.

These results are overwhelmingly positive – and it could be biased.

Potential Bias 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 follow-up visit.

The only person currently offering – and therefore profiting – from Etanercept for stroke recovery is Dr. Edward Tobinik.

Tobinik was involved in the only clinical trials (one in 2011 and 2012) currently conducted on Etanercept for stroke.

Eventually, the American Academy of Neurology (AAN) caught wind of this and issued a warning.

AAN Issues Advisory for Etanercept in Post-Stroke Disability

To further complicate the issue, the American Academy of Neurology (AAN) published a practice advisory in 2016 on the use of etanercept for stroke recovery.

The AAN states that there is insufficient evidence to determine the effectiveness of etanercept for post-stroke disability. It also cites that the treatment may be associated with adverse outcomes and high cost.

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.

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The AAN also states:

“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 the 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 reprimands 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 by 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

Fda research on use of etanercept for stroke patients

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 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 physical therapy exercises helps the brain rewire itself to improve movement.

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It takes hard work – much more work than a single injection of Etanercept – but it’s has a proven track record of working.

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


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About the Author: Tung Chi