After having found out that my pharmacy had forgotten to refrigerate my
Enbrel refill for a day and a half, I called Amgen/Enbrel to update my
understanding of their policy in such cases.  Not totally satisfied with the
nurse's response, I was redirected to a second level nurse.  I was
essentially told the following.

Amgen does not recommend any deviation from the 36 to 46 degree temperature
range for Enbrel storage.

She went on to state, however, that Amgen has "effectiveness studies" that
indicate Enbrel retains a level of viability as long as the temperature is
not kept higher than 77 degrees F for up to 45 days.  Amgen's effectiveness
studies indicate that Enbrel is to be consumed before the 45th day beginning
when the medicine was first discovered being stored outside the recommended
temperature.  In other words, if one had a two-week supply that was
discovered outside the recommended temperature range on Day 1, that supply
must be used before Day 45 -- which essentially means that Enbrel could sit
around at 77 degrees for more than 30 days and still retain some level of
effectiveness.  However, a copy of this effectiveness study is not available
to the consumer as far as I could determine.  I was unable to find out
anything about the characteristics of this study, i.e., what is the
effectiveness level at Day 1 outside the recommended temperature range, at
Day 2, at Day 30.  It would stretch believability that the Food and Drug
Administration has approved usage of Enbrel for up to 45 days when the
medicine is not stored in compliance with the stated 36 to 46 degrees F
temperature range that was established during the testing trials.

The bottom line according to this second level nurse is, again, Amgen does
not recommend any deviation from the 36 to 46 degree F temperature range
while stored.  This is their official policy.  The nurse further went on to
state that it is always up to the user to decide if they will use Enbrel
that has been improperly stored -- notwithstanding Amgen's effectiveness
studies.