Although this is the first study to the best of our knowledge that economically evaluated TOZ versus other commonly used TNFi (ADM, ETC) for managing RA using real-world data in Saudi Arabia, it has multiple limitations that must be acknowledged, first, the study used surrogate laboratory markers (CRP and ESR) instead of more comprehensive and valid measures, such as DAS28 [30], to assess the effectiveness of TOZ versus ADM, ETC. This evidence concerns the gene ESR1 and rheumatoid arthritis.