adalimumab + etanercept + rituximab

This is a combination of three biologic disease-modifying antirheumatic drugs (DMARDs): adalimumab, etanercept, and rituximab. All three are monoclonal antibody-based therapies or fusion proteins used primarily in the treatment of autoimmune diseases such as rheumatoid arthritis. - **Adalimumab** is a fully human monoclonal antibody that binds to tumor necrosis factor alpha (TNF-α), inhibiting its interaction with TNF receptors and thereby reducing inflammation[9][2]. - **Etanercept** is a dimeric fusion protein consisting of the extracellular ligand-binding portion of the human p75 TNF receptor fused to the Fc portion of IgG1; it acts as a decoy receptor for TNF-α, removing it from circulation and preventing its pro-inflammatory effects[8][2]. - **Rituximab** is a chimeric monoclonal antibody targeting CD20 on B lymphocytes, leading to their depletion from circulation and modulating immune responses[2][1]. The concurrent use of multiple biologics such as these is rare due to increased risk for serious adverse events, particularly infections. While combinations like adalimumab plus etanercept or rituximab plus another biologic have been studied in refractory cases, triple biologic therapy with all three agents together has not been established as standard practice due to safety concerns[7].