Adherence to ursodeoxycholic acid therapy in patients with cholestatic and autoimmune liver disease.

•Adherence to medication is often suboptimal, especially during long-term therapy. In this prospective study in 75 patients with cholestatic and autoimmune liver disease, adherence to ursodeoxycholic acid was measured both with real time medication monitoring and patient reported adherence.•Eighty-nine percent of the patients exhibited good adherence and 11% poor adherence according to real time medication monitoring.•Poor adherence was associated with young age and male gender.•Despite the excellent safety profile of ursodeoxycholic acid, only 42% of all patients were accepting, whereas 50% ambivalent, and 8% indifferent to therapy.•Of all patients, 92% had a strong belief that UDCA is highly necessary for their health, but at the same time 50% were worried about the possibility to become addicted to this medication and/or to experience adverse events.