OBJECTIVES: To evaluate effects of dose escalation on clinical outcomes of RA patients initiating TNF-blocker treatments in community practice.  METHODS: TNF-blocker-naïve adult RA patients initiating etanercept, adalimumab, or infliximab (index) between July 1, 2005 and May 31, 2008 with ≥12 months’ enrollment post-index were identified from the Ingenix database. Patients receiving <9 months TNF-blocker treatment or diagnosed with psoriasis, psoriatic arthritis, ankylosing spondylitis, or Crohn’s disease were excluded. Rates of dose escalation using 3 different methods were calculated using claims data. Participating physicians provided de‑identified charts. Each chart was reviewed by 4–6 clinical rheumatologists to evaluate and agree on overall clinical change from baseline to the visit closest to 1 year post-index (12±3 months). Multivariate models compared change in clinical outcomes and dose escalation rates, controlling for differences among etanercept, adalimumab, and infliximab patients at index. RESULTS: Overall, 715 etanercept, 501 adalimumab, and 393 infliximab patients were identified from claims; 141 etanercept, 115 adalimumab, and 104 infliximab patients had evaluable charts. Patient characteristics were similar among the claims and charts. Regardless of dose escalation method used, significantly fewer etanercept-treated patients had dose escalations (1.8%, 5.2%, 6.7%) than patients treated with adalimumab (9.8%, 8.6%, 10.4% respectively) or infliximab (50%, 31%, 34% respectively) (p<0.05 for all comparisons). After treatment initiation, 86% of etanercept-treated patients had “much better” or “better” clinical outcomes at 12±3 months, versus 82% of adalimumab patients and 78% of infliximab patients. Multivariate analyses showed significantly fewer dose escalations in etanercept patients (p<0.05), with no significant difference in clinical change score between etanercept patients and adalimumab (p=0.22) or infliximab (p=0.07) patients. CONCLUSIONS: This study showed dose escalation in fewer etanercept than adalimumab or infliximab patients, but similar improvements in clinical outcomes for all 3 treatments, indicating that higher dose escalation rates may not be associated with better clinical outcomes.