OBJECTIVES: To characterize one-year follow-up rates of treatment response parameters in new users of tumor necrosis factor (TNF)-alpha inhibitors for rheumatoid arthritis in nationally representative medicare and commercial claims databases. METHODS: A retrospective cohort analysis of RA patients in the 2011 Truven MarketScan database was conducted. Subjects were required to have RA based on ICD-9 code, at least one claim for one of the TNF-alpha inhibitors and 12 months continuous enrollment before and after the first TNF-alpha inhibitor claim. Adherence was defined as medication possession ratio of at least 80%. Glucorticoid equivalent dose of at least 10 mg designated flare management. Analyses conducted using SAS 9.4 (Cary, NC) and Python 9.4.3 (Python Software Foundation). RESULTS: In the Medicare cohort (n=8,123), 33.0% of new users experienced a 60 day gap or more or switched TNF-alpha inhibitors. Regarding adherence, 37.2% were non-adherent. In terms of glucorticoid usage, 7.2% of the cohort failed based on increased glucorticoid dose and 4.0% failed based on glucocorticoid initiation. In terms of DMARDs, 67.2% of the cohort used a DMARD concurrently with TNF-alpha inhibitor use. Outpatient costs during the study period were an average of $413 and TNF-alpha inhibitor costs were an average of $20,516. In the commercial cohort (n=41,244), 41.0% of new users experienced a 60 day gap or more or switched TNF-alpha inhibitors. Regarding adherence, 47.2% were non-adherent. In terms of glucorticoid usage, 7.7% of the cohort failed based on increased use of glucorticoid and 4.3% failed based on glucocorticoid initiation. In terms of DMARDs, 73.4% of the cohort used a DMARD concurrently with TNF-alpha inhibitor use. Outpatient costs during the study period were an average of $518 and TNF-alpha inhibitor costs were an average of $19,558. CONCLUSIONS: Substantial discontinuation and nonadherence present challenges to RA management. Developing means of improving appropriate use are needed.