Background: to improve ankylosing spondylitis (AS) treatment outcomes by clarifying the impact of biological medication adherence on their treatment outcomes, quality of life and work productivity. Methods: Sixty -six patients with AS were included according to eligibility criteria recruited from Rheumatology and Rehabilitation department at Zagazig University Hospitals(ZUH) and insurance hospital. Patients characteristics are collected. Biologics medication adherence was evaluated by the Compliance Questionnaire on Rheumatology (CQR). Disease activity and treatment response outcome measures were recorded at base line of biologics, after 6 month and after one year. Results: Insurance, education, employment and early diagnosis are the modifiable factors which can increase adherence to biologics drugs in adherent cases ASDAS CRP,and ASDAS ESR were significantly decreased after 6 months and highly significantly decreased after 12 months. BASFI & BASMI were significantly decrease after 12 months , frequency of overall work and activity impairment was decreased after 6 months but after 12 months the decrease became significant with percent of reduction in both more than 50%. Also AS quality of life (ASQOL) significant decreased after 6 months and 12 months. In non -adherent there was a significance increase in ASQOL score after 12 months. Conclusion: Biological therapy adherence leads to control disease activity confirmed by percentage of change in activity parameters after 6 months and highly significant change after 12 months of follow up especially BASMI in addition to improvements of work productivity and activity impairment and overall health -related quality of life, even in non -adherent who gain partial improvement. Keywords: Ankylosing Spondylitis; biologic drugs adherence; treatment outcomes; work productivity.