Using different operational definitions, Nair et al. [35] found that 45% of commercially-insured patients with evidence of infliximab as a first-line biologic therapy had a dose escalation (difference between first and final doses) in the first year of therapy and, in a report based on a Dutch registry of patients with RA who started a first anti-TNF agent, Blom et al. [36] found dose increases in 36% of infliximab patients, 12% of adalimumab patients, and 8% of etanercept patients. Here, TNF is linked to rheumatoid arthritis.