OBJECTIVES:  To estimate dose escalation rates of etanercept, adalimumab, and infliximab for RA patients initiating and continuing TNF-blockers METHODS:  This retrospective analysis in the HealthCore Integrated Research Database identified adult (18-64 years) RA patients with ≥1 claim for etanercept, adalimumab, or infliximab between July 1, 2007 and January 31, 2010 (first claim=index).  Patients were continuously enrolled for 6 months prior to index; patients with TNF-blocker claims within 6 months prior to index were considered continuing therapy.  Patients with other indicated conditions or contraindicated to RA biologic therapy were excluded.  Dose escalation, assessed over a 12-month period of continuous treatment (<60-day gap), was defined as: 1) 2+ instances in which subsequent doses were ≥130% of index dose or 2) any instances with increased number of syringe/vial or shortened dosing interval. RESULTS:  Overall, 3868 patients were included (mean age 50.1 years; 74.4% female).  Among new patients (932 etanercept; 267 adalimumab; 292 infliximab), 4.4%, 9.0%, and 42.5% of etanercept, adalimumab, and infliximab patients, respectively, had 2+ instances of dose escalation (P<0.001 for all 2-way comparisons).  Most new patients (85.3% etanercept; 92.1% adalimumab; N/A infliximab) initiated therapy at recommended dose; of these patients, 2.3%, 12.6%, and 59.9% of etanercept, adalimumab, and infliximab patients, respectively, increased by ≥1 syringe/vial or shortened dosing frequency.  Among continuing patients (1078 etanercept; 480 adalimumab; 819 infliximab), 6.0%, 16.9%, and 29.1% of etanercept, adalimumab, and infliximab patients, respectively, had 2+ instances of dose escalation (P<0.0001 for all 2-way comparisons).  Most continuing patients (93.5% etanercept; 95.6% adalimumab; N/A infliximab) received the index dose at recommended dose; of these, 4.1%, 19.6%, and 79.5% of etanercept, adalimumab, and infliximab patients, respectively, increased by ≥1 syringe/vial or shortened dosing frequency. CONCLUSIONS:  Etanercept had lower dose escalation rates for new and continuing patients compared with adalimumab and infliximab in a large US managed care plan.