OBJECTIVES: Poor compliance/adherence has been shown to be one of the leading causes for sub-optimal clinical benefit. Overall adherence in chronic diseases averages 50%, in rheumatoid arthritis (RA) 50-70%. A comprehensive literature survey was performed to explore the field of compliance with biologic DMARDs (bDMARDs), in particular regarding patient satisfaction with different regimens, and to assess predicting factors of compliance in RA treatment in general. METHODS: Relevant articles were identified through search in a DIMDI Superbase (10 databases). Three search concepts were combined: compliance in RA treatment 1) with bDMARDS, 2) with focus on different administration modes 3) in general (reviews >1990). Additionally, bibliographies and the Internet were reviewed. Juvenile arthritis was excluded. RESULTS: Focus and approach of the identified publications are highly varied. However, there are only a few reliable data. So far, published compliance data with bDMARDs are quasi limited to the first two approved drugs. Compliance rates of bDMARDs tend to be higher than those for RA in general, calculated on basis of prescription refills (Olszynski 2004, Harley 2003). Patients' preferences were evaluated in three surveys. Two compared twice-weekly subcutaneous (SC) injections with bi-monthly intravenous (IV) infusions, showing a tendency in preference towards bi-monthly IV infusion. Factors influencing compliance in RA treatment are older age, female sex, decreased disability, and satisfactory contacts with healthcare professionals (Viller 1999). Patient education showed positive (Viller 1999, Hill 2001) or no effects (Brus 1998). Less frequent dosing regimens (Claxton 2001) resulted in better compliance, also bi-monthly IV infusion versus twice-weekly SC injection (Jarry 2002). CONCLUSIONS: Compliance with bDMARDs appears to be higher than with traditional RA treatment. Patients' preference regarding administration mode tends towards IV infusion but needs further investigation, distinguishing between kind and frequency of administration. Due to the poor data compliance with bDMARDS needs further qualitative and quantitative investigation.