adalimumab + etanercept + infliximab + methotrexate

This is a combination therapy consisting of three anti-tumor necrosis factor (anti-TNF) monoclonal antibodies—adalimumab, etanercept, and infliximab—together with methotrexate, a disease-modifying antirheumatic drug (DMARD). Each anti-TNF agent targets and neutralizes tumor necrosis factor alpha (TNF-α), a key cytokine involved in inflammatory processes. Methotrexate acts as an immunosuppressant by inhibiting dihydrofolate reductase, reducing DNA synthesis and immune cell proliferation. While each anti-TNF agent is commonly used individually or in combination with methotrexate for conditions such as rheumatoid arthritis and Crohn’s disease[1][2][5][6], there is no clinical evidence supporting the simultaneous use of all three biologics plus methotrexate due to increased risk of immunosuppression and adverse effects. In practice, combinations typically involve one anti-TNF agent plus methotrexate rather than multiple biologics together.