Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2017 ; Objective: Analyse the evolution of biological tumour necrosis factor alpha (TNFalpha) inhibitors utilisation in the treatment of rheumatoid arthritis (RA) and identify the reasons for the observed variation. Methods: Two western European countries were selected for this analysis, Portugal and the Netherlands. Country characteristics, treatment guidelines and RA prevalence were obtained from the literature. Patient characteristics were obtained from the literature and from the data made available by the University Medical Center Utrecht, for Portugal and the Netherlands, respectively. Annual utilisation rates of TNFalpha inhibitors between 2008 and 2013 were expressed as defined daily doses (DDDs)/1000 inhabitants/day. Results: TNFalpha inhibitors utilisation varied from 0.18, in 2008, to 0.46 DDDs/1000 inhabitants/day, in 2013, in Portugal and from 0.98, in 2008, to 1.64 DDDs/1000 inhabitants/day, in 2013, in the Netherlands. Clinical guidelines, variations in GDP per capita, total health expenditure, medical goods expenditure and drug distribution channel, appear to have had limited impact on TNFalpha inhibitors utilisation. On average, Dutch RA patients under therapy with TNFalpha inhibitors appear to younger than their Portuguese counterparts. Conclusions: TNFalpha inhibitors utilisation continues to be increasing, despite the negative influences caused by the economic recession and posterior austerity measures. This increase in TNFalpha inhibitors utilisation was not equal in Portugal and in the Netherlands, which lead to a bigger difference in utilisation between both countries. The high percentage of undiagnosed Portuguese rheumatic patients might be one of the leading reasons for the anaemic utilization of TNFalpha inhibitors. The number of rheumatologists per 100,000 inhabitants, improved clinical efficiency and a reduction in drug pricing all seem to have positively influenced ...