Abdulla, A., Younis, A., Aladul, M. (2026). Disease Activity and Safety of Altebrel in Iraqi Rheumatoid Arthritis: A Retrospective Study. , 23(2), 73-78. doi: 10.33899/iraqij.p.2026.169730.1190
Anfal A. Abdulla; Ali A. Younis; Mohammed Ibrahim Aladul. "Disease Activity and Safety of Altebrel in Iraqi Rheumatoid Arthritis: A Retrospective Study". , 23, 2, 2026, 73-78. doi: 10.33899/iraqij.p.2026.169730.1190
Abdulla, A., Younis, A., Aladul, M. (2026). 'Disease Activity and Safety of Altebrel in Iraqi Rheumatoid Arthritis: A Retrospective Study', , 23(2), pp. 73-78. doi: 10.33899/iraqij.p.2026.169730.1190
Abdulla, A., Younis, A., Aladul, M. Disease Activity and Safety of Altebrel in Iraqi Rheumatoid Arthritis: A Retrospective Study. , 2026; 23(2): 73-78. doi: 10.33899/iraqij.p.2026.169730.1190

Disease Activity and Safety of Altebrel in Iraqi Rheumatoid Arthritis: A Retrospective Study

Iraqi Journal of Pharmacy
Article 4, Volume 23, Issue 2, June 2026, Pages 73-78    PDF (531.86 K)
Document Type: Research Paper
DOI: 10.33899/iraqij.p.2026.169730.1190
Authors
Anfal A. Abdulla1; Ali A. Younis2; Mohammed Ibrahim Aladul* 1
1Department of Clinical Pharmacy, College of Pharmacy, University of Mosul, Mosul, Iraq
2Department of Internal Medicine, College of Medicine, University of Mosul, Mosul, Iraq
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease whose global burden is rising. Etanercept biosimilars and intended copies broaden access in low-income settings, but real-world evidence from Iraq and about Altebrel are scarce. Objective: To evaluate disease activity at assessment, safety, and predictors of moderate/high disease activity among Iraqi adults with rheumatoid arthritis treated with Altebrel in routine practice. Methods: This was a single-center retrospective observational study with cross-sectional disease activity assessment and retrospective laboratory comparison (medical record review) of adults with RA who were biologic-naïve or previous biologic users who had switched to Altebrel. Retrospectively collected data included demographics (age, sex), clinical characteristics (disease duration, body mass index, smoking status), treatment variables (methotrexate use, prior biologic use), adherence (refill-based), laboratory parameters (CRP, ESR, urea, creatinine, liver enzymes), and DAS28 at assessment. Associations between adherence and Disease Activity Score in 28 joints (DAS28) were explored with Spearman’s correlation. Multivariable logistic regression estimated predictors of moderate/high disease activity (DAS28 ≥ 3.2). Results: One hundred patients (80 % female; mean age 48 ± 11 years) were analyzed. DAS28 at assessment was higher in previous biologic users than in biologic‑naïve patients (median 4.34 vs 3.73; p=0.048). Age independently predicted moderate/high disease activity (odds ratio 1.07 per year; 95% confidence interval 1.01–1.14); adherence, smoking, methotrexate use, and marital status were not significant. Urea levels declined modestly after Altebrel (median 5.1 (3.9 - 6.6) to 4.4 (3.3 - 5.2) mmol/L, p=0.027), whereas creatinine and liver enzymes remained stable. Conclusions: In this Iraqi cohort, Altebrel therapy achieved moderate disease control with no major short-term safety concerns. Older age—but not adherence, smoking or marital status—predicted higher disease activity. These findings support the real-world use of Altebrel and highlight the need for treat-to-target strategies and prospective studies in the region.
Keywords
Adherence; Etanercept; Iraq; Rheumatoid arthritis; Tumor necrosis factor inhibitor
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