OBJECTIVES: To evaluate persistence of anti-tumor necrosis factor (anti-TNF) treatment among rheumatoid arthritis (RA) patients utilizing a managed care database. METHODS: A retrospective study utilizing the PharMetrics managed care claims database was conducted. The first anti-TNF (infliximab, etanercept, or adalimumab) encounter (index date) among RA patients between January 1, 2001 and January 1, 2004 was identified. Patients were required to have a minimum of 12-months of continuous plan eligibility prior to and following their index biologic date. Three mutually exclusive cohorts were developed based on their index biologic;infliximab plus methotrexate (MTX); etanercept plus MTX; and adalimumab plus MTX.Anti-TNF persistence (%) was defined as the number of days between the first biologic prescription and their last biologic encounter, divided by 365 and multiplied by 100. Both univariate and multivariate analyses were applied to determine if differences in persistence existed between the three cohorts. RESULTS: A total of 1,242 patients were analyzed consisting of 490 (39.4%) infliximab plus MTX; 607 (48.9%) etanercept plus MTX; and 145 (11.7%) adalimumab plus MTX. Over two-thirds of the patients were female and the mean age was 50.0 years. The Charlson Co-morbidity Index and disease staging were consistent among the three cohorts. The infliximab plus MTX cohort was more persistent [78.0% than the other 2 cohorts (etanercept plus MTX 73.6% and adalimumab plus MTX 70.8%)] and was statistically significant (p<0.05). After adjusting for potential confounding variables (age, gender, Charlson co-morbidity index and disease severity), infliximab patients had 5.4% more persistence than etanercept (p<0.01), and 7.0% more than the adalimumab group (p<0.05). Etanercept patients were more persistent than the adalimumab group, however, the difference was not significant (p>0.05). CONCLUSION: These results indicate that patients on infliximab plus MTX are more persistent with anti-TNF therapy, compared to other anti-TNFs. Further studies are needed to evaluate the impact of persistence on clinical outcomes.