Adalimumab, Rituximab Most Commonly Used Anti-inflammatory Agents, Says Longitudinal Study

Adalimumab was the most commonly used tumor necrosis factor-alpha inhibitor (TNFi), accounting for 47% of 90,000 incidences of TNFi use. Rituximab was the most commonly used non-TNFi, for 44% of 70,000 incidences of non-TNFi use.

A longitudinal study looking into utilization patterns of anti-inflammatory agents across more than 90,000 patients is giving insight into which tumor necrosis factor-alpha inhibitors (TNFi) and non-TNFi treatments are most often used.

Adalimumab was the most commonly used TNFi drug, accounting for 47% of all 90,000 incidences of TNFi use. Meanwhile, rituximab was the most commonly used non-TNFi drug, accounting for 44% of the 70,000 incidences of non-TNFi use.

Findings were published recently in Pharmacology Research & Perspectives.

“Also, adalimumab had the highest increase in the number of incident episodes (through 2017,

the most recent year of complete data), while the utilization for rituximab was relatively stable,” wrote the researchers, who analyzed data from 2012 through 2017. “The biologic agents with more than 10,000 incident use episodes were adalimumab, rituximab, etanercept, infliximab, and ustekinumab. All of these drugs were initially approved by the FDA before 2010, had expanded indications over time, and included indications across therapeutic areas.”

The data, which was compiled from the Biologic and Biosimilars Collective Intelligence Consortium's Distributed Research Network, also showed that infliximab-abda and infliximab-dyyb were the most frequently used biosimilars, although use was limited. The researchers noted that their more recent approvals—for 2017 and 2016, respectively—mean it’s too soon to study their utilization patterns and the impact on the originator drug.

According to the researchers, greater variation in the use of biologics should be expected as more biologics and their biosimilars continue to enter the market, driving more competition. At the same time, close surveillance on the rare but potentially serious adverse events will be important to compare the profiles of different options in real-world use, they say.

“Several factors need to be considered in interpreting these results. Our data are generally representative of commercially insured individuals in the United States. Whether these findings would be applicable to other populations, for example, older patients with only Medicare insurance coverage, is uncertain,” commented the researchers, “Also, as 2018 and 2019 data were partially complete, we were not able to fully analyze trends in utilization beyond 2017. Finally, there is the possibility of misclassification in identifying drug exposures and clinical characteristics through administrative claims data.”

Looking forward, the researchers highlighted the value of future efforts assessing how utilization patterns are impacted by certain factors, such as treatment cost, route of administration, prevalence of indications, adverse events, step therapy, patient and provider preferences, and pharmacy benefit programs.


Mendelsohn A, Nam Y, Marshall J, et al. Utilization patterns and characteristics of users of biologic anti-inflammatory agents in a large, US commercially insured population. Pharmacol Res Perspect. 2021;9:e00708. doi:10.1002/prp2.708