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This article is part of the supplement: Current and new antitumor necrosis factor agents in perspective

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Does route of administration affect the outcome of TNF antagonist therapy?

Sergio Schwartzman1* and G James Morgan2

Author affiliations

1 Hospital for Special Surgery, New York, NY, USA

2 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

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Citation and License

Arthritis Res Ther 2004, 6(Suppl 2):S19-S23  doi:10.1186/ar996

Published: 21 June 2004


The tumor necrosis factor (TNF) antagonists are parenterally administered biologic response modifiers indicated for the management of rheumatoid arthritis. Although infliximab, etanercept, and adalimumab are all members of this class, they differ in route of administration and dosing regimen. In the USA and in Europe, infliximab, in combination with oral methotrexate, is administered intravenously, initially at a dose of 3 mg/kg at weeks 0, 2, and 6, then every 8 weeks thereafter. The US Food and Drug Administration (FDA) has further approved that the dosage can be increased to 10 mg/kg and the doses can be given as often as every 4 weeks to optimize patient outcome (information based on the US package insert dated June 2002). Etanercept and adalimumab are given subcutaneously and can be self-injected. The FDA-approved dose of etanercept is 25 mg twice weekly, and of adalimumab is 40 mg every 2 weeks with methotrexate, or 40 mg alone. Medication adherence, possibly the most important factor in maintaining the benefits of anti-TNF therapy, is influenced by the interaction between the patient and his or her healthcare team, the patient's attitude toward the disease and medication regimen, and the choice of therapy.

adherence; efficacy; intravenous; rheumatoid arthritis; subcutaneous; tumor necrosis factor