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.
Abdulla et al. (Sun,) studied this question.