Background and Objective: Inflammatory bowel disease (IBD) management relies on biological therapies. However, poor medication adherence remains a challenge, linked to worsened outcomes. C-reactive protein (CRP) is a key marker of disease activity in IBD. This study investigated the relationship between adherence barriers and disease severity, measured by CRP, in Iraqi IBD patients.
Methods: A cross-sectional study enrolled 100 adult IBD patients on biological therapy for ≥6 months at a Gastroenterology and Hepatology teaching hospital in Baghdad province in the period from December 2024 to February 2025. Disease severity was assessed by determining serum CRP levels. Adherence barriers were evaluated using the Adherence Barriers Questionnaire, measuring four subscales: Intentional, Unintentional, Medication-related, and Healthcare system-related barriers (higher scores indicate greater barriers) and correlated with the sociodemographic data and the severity of the disease.
Results: Most sociodemographic factors showed no significant association with CRP levels or adherence barrier subscales. Exceptions included higher Healthcare system-related barriers in single vs. married patients (p=0.025), and significant associations between Unintentional barriers and lower education levels (p=0.003) and middle-income levels (p=0.009). Patients with elevated CRP exhibited significantly higher scores across all four adherence barrier subscales compared to those with normal CRP.
Conclusion: Significant associations demonstrated between elevated CRP related to disease activity and increased adherence barriers across all categories in Iraqi IBD patients. While sociodemographic factors had minimal overall influence, marital status, education, and income impacted specific barriers with minimal effect. Addressing these modifiable adherence barriers is essential for improving disease control in IBD management.