OBJECTIVES: Real-world data on long-term dosing patterns in first time anti-TNFα inhibitor treated rheumatoid arthritis patients is lacking. Such data are important for the calculation of treatment cost, especially for products where the label allows for varying doses and frequency of administrations. METHODS: The Dutch Rheumatoid Arthritis Monitoring (DREAM) project is a longitudinal, multi-centre patient register monitoring biologic DMARD usage in clinical practice since February 2003. Patients meeting the Dutch reimbursement criteria (DAS28>3.2, inadequate response to ≥2 DMARDs including methotrexate, no prior bDMARDs) were assessed at three-month intervals for 48 months. Dosing was determined by the attending rheumatologist guided by the recommended labelled doses (adalimumab 40mg every other week, etanercept 25mg twice weekly, infliximab 3mg/kg at week 0, 2, 4, 8 and every 8 weeks thereafter). Mean dose was calculated based on the actual dose prescribed at each visit and the change over time evaluated for each anti-TNFα. RESULTS: The mean baseline doses for adalimumab (N=374), etanercept (N=432) and infliximab (N=325) were 39.9 mg/two weeks, 24.2 mg twice weekly, and 3.4 mg/kg per eight weeks. Mean baseline DAS28 and HAQ ranged from 5.2-5.4 and 1.3-1.4, respectively. Nearly one-third of infliximab patients were prescribed greater than the labelled dose at baseline (32%, N=105) compared to 2.5% and 0.2% for adalimumab and etanercept. At 12, 24, and 48 months follow-up, mean doses were: adalimumab, 41.5, 43.3, and 45.7mg/two weeks (42 months); etanercept, 24.0, 24.9, and 23.9mg twice per week (45 months); infliximab, 4.3, 4.9, and 4.9mg/kg/every eight weeks (48 months). Mean doses in infliximab patients prescribed greater than the recommended labelled dose at baseline were 4.7, 5.2, and 5.6 mg/kg at the same follow-up intervals. CONCLUSIONS: Longitudinal patient registry data from the Netherlands show a marked and continued dose escalation in RA patients prescribed infliximab as a first-line anti-TNFα when compared to either adalimumab or etanercept.