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Etanercept and methotrexate for the treatment of rheumatoid arthritis

Nobuyuki Miyasaka

Rheumatoid arthritis (RA) affects approximately 1% of the population, resulting in disturbances of daily activity and quality of life. Tumor necrosis factor (TNF)-α has been implicated in the pathogenesis of RA, and the blockade of TNF-α with anti-TNF-α monoclonal antibodies (infliximab and adalimumab) and the soluble TNF-α receptor (etanercept) has caused a dramatic paradigm shift in the treatment of RA. Etanercept is a safe, highly effective biological agent in the treatment of RA. It can be used alone or with methotrexate, but the combination of the two is highly efficacious compared with monotherapy using etanercept. The most significant benefit of etanercept is to inhibit the progression of joint destruction. Although etanercept is well tolerated, its long-term safety, including the occurrence of malignant lymphoma, remains to be elucidated.