• HALA F. KASIM Asis. Lecturer, Department of Clinical Pharmacy, College of the Pharmacy, University of Mosul, Mosul, Iraq.
  • HISHYAR M. SALIH Lecturer, Department of Clinical Pharmacy, College of the Pharmacy, University of Duhok,
  • SOUZAN H. EASSA Assistant Prof, Department of Anatomy and Biology, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Keywords: Adherence, biological drugs, medication adherence scale


Background: The need for ongoing treatment to manage immune-mediated inflammatory diseases is a challenge for health care providers, as there is always an attempt to achieve clinical remission as much as possible.

Objective: This study aimed to estimate the prevalence of non-adherence to biological drugs and factors affecting it among patients in Duhok governorate-Iraq.

Patients and Methods: A cross-sectional questionnaire-based study was conducted between December 2018 to October 2019 at the specialized center of rheumatic disease and medical rehabilitation in Duhok city. One hundred forty-four patients who lived in Duhok governorate out of 216 registered cases were included, each with the established disease for at least 12 months, and had been taking biological drugs (Etanercept, Infliximab, and Adalimumab) with or without conventional drugs for at least three months were involved in this study. Disease activity scales as appropriate to each disease were used, with using a medication adherence scale to assess the adherence to medications.

Results: From the total of 144 patients included in this study, 134 (93.1%) of them were non-adherent compared to only 10 (6.9%) of patients who were adherent to medication intake. Significant associations existed between adherence to the medications and different factors. These factors with the corresponding percentages of non-adherence were as follows: age between 30-39 (34.3%), illiterate/ primary education (56.0%), unemployed (64.9%), no ability to buy biologic drugs (82.1%), etanercept users (71.6%) and (56.7%) were using biological drugs for less than four years.

Conclusion and recommendation: With the existence of multiple factors effect on adherence to medications and due to the inconsistency of these factors, routine measurements of adherence to medications are essential in achieving the desired therapeutic goal.


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