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TNF-α Blocker Therapy and Solid Malignancy Risk in ANCA-Associated Vasculitis

  • VASCULITIS (LR ESPINOZA, SECTION EDITOR)
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Abstract

ANCA-associated vasculitides (AAV) are small vessel systemic vasculitis syndromes associated with the potential for high morbidity and mortality. This group includes granulomatosis with polyangiitis (Wegener´s, GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA). The standard treatment consists of a combination of glucocorticoids and potent immunosuppressant drugs. These have broad mechanisms of action as well as important adverse effects. Efforts have been made to investigate novel agents with better-defined and narrower mechanisms of action, such as biologics, including TNF-α blockers. Etanercept, a well-known TNF-α blocker evaluated for GPA in the Wegener’s Granulomatosis Etanercept Trial (WGET), was associated with an increase in the development of solid malignancies in comparison to placebo during that trial period. A 5-year follow-up after the WGET trial showed a sustained increase in incidence of solid malignancies, but this could no longer be solely attributed to etanercept exposure. These studies raised concerns about the use of the family of TNF-α blockers in AAV. Here, we review the evidence about the association between therapeutic inhibition of tumor necrosis factor (TNF-α) by etanercept and other TNF-α blockers with the development of solid malignancies in GPA and other AAV.

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Disclosure

Dr. Specks has served as a consultant for and received grant support from Genentech.

Drs. Silva and Cisternas reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 352, Santiago, Chile

    Francisco Silva & Marcela Cisternas

  2. Thoracic Disease Research Unit, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Ulrich Specks

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  1. Francisco Silva
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  2. Marcela Cisternas
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  3. Ulrich Specks
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Correspondence to Francisco Silva.

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Silva, F., Cisternas, M. & Specks, U. TNF-α Blocker Therapy and Solid Malignancy Risk in ANCA-Associated Vasculitis. Curr Rheumatol Rep 14, 501–508 (2012). https://doi.org/10.1007/s11926-012-0290-2

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