What is the role of etanercept in the treatment of granulomatosis with polyangiitis (GPA)?

Updated: Oct 09, 2019
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Etanercept is a dimeric, recombinant human fusion protein with 2 soluble p75 tumor necrosis factor ̶ alpha (TNF-α) receptors linked to the Fc region of human IgG1. The initial pilot study showed good response when etanercept was added to standard therapy. [95]

The larger Wegener Granulomatosis Etanercept Trial (WGET), which subsequently assessed the efficacy of etanercept in the treatment of GPA, suggested that etanercept does not improve AAV relapses and likely contributes to increased risk of infection and malignancy. Etanercept or placebo was added to standard therapy (corticosteroids plus cyclophosphamide or methotrexate). No improvement was found in the primary endpoint of sustained remission; moreover, more solid cancers were found in the etanercept group. [13] Additionally, the combination of anti-TNF therapy with an alkylating agent (ie, cyclophosphamide) may increase risk of solid tumors.


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