Background Adalimumab and etanercept are both anti-TNF drugs used to treat various autoimmune pathologies.

Purpose The purpose of this study was to evaluate the use of adalimumab and etanercept in authorised and unauthorised indications (off label use) and evaluate the effect on finances of the treatments carried out in the latter situation.

Materials and methods A retrospective and observational study was carried out from 1 January 2010 to 30 September 2011, of all patients who started treatment with adalimumab or etanercept in the outpatient dispensing area. Data were obtained through the CAFyDIM program.

Results During the study 111 patients started treatment with adalimumab. Distribution of pathologies was: Crohn's disease (21 patients), psoriasis with arthropathy (21 patients), rheumatoid arthritis (16 patients), ankylosing spondylitis (14 patients), psoriasis (11 patients), juvenile rheumatoid arthritis (7 patients) and ulcerative colitis (5 patients). Off label use: panuveitis (nine patients), Behçet's Syndrome (two patients), undifferentiated seronegative spondyloarthropathy (one patient), polyarthritis associated with ulcerative colitis (one patient), systemic sarcoidosis (one patient), HLA B27 (+) polyarthritis (one patient). The cost incurred by these latter treatments was 132.972€, 4.67% of the total expenditure generated by adalimumab in the study period. 75 patients started treatment with etanercept. Distribution of pathologies was: rheumatoid arthritis (28 patients), psoriasis (21 patients), juvenile rheumatoid arthritis (13 patients), psoriasis with arthropathy (9 patients) and ankylosing spondylitis (4 patients).

Conclusions Etanercept is used in our hospital in approved conditions of use. However, although adalimumab in most cases is used in approved indications, in 13.6% of cases it is used for indications outside the SPC.