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Journal of Nephrology
Published in: Journal of Nephrology 3/2017

Open Access 01-06-2017 | Review

Atypical hemolytic uremic syndrome in the setting of complement-amplifying conditions: case reports and a review of the evidence for treatment with eculizumab

Authors: Arif Asif, Ali Nayer, Christian S. Haas

Published in: Journal of Nephrology | Issue 3/2017

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Abstract

Atypical hemolytic uremic syndrome (aHUS) is a rare, genetic, progressive, life-threatening form of thrombotic microangiopathy (TMA) predominantly caused by dysregulation of the alternative pathway of the complement system. Complement-amplifying conditions (CACs), including pregnancy complications [preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome], malignant hypertension, autoimmune diseases, transplantation, and others, are associated with the onset of TMA in up to 69 % of cases of aHUS. CACs activate the alternative pathway of complement and may be comorbid with aHUS or may unmask a previously undiagnosed case. In this review, three case reports are presented illustrating the onset and diagnosis of aHUS in the setting of different CACs (pregnancy complications, malignant hypertension, renal transplantation). The report also reviews the evidence for a variety of CACs, including those mentioned above as well as infections and drug-induced TMA, and the overlap with aHUS. Finally, we introduce an algorithm for diagnosis and treatment of aHUS in the setting of CACs. If TMA persists despite initial management for the specific CAC, aHUS should be considered. The terminal complement inhibitor eculizumab should be initiated for all patients with confirmed diagnosis of aHUS, with or without a comorbid CAC.
Literature
1.
2.
3.
4.
Fremeaux-Bacchi V, Fakhouri F, Garnier A et al (2013) Genetics and outcome of atypical hemolytic uremic syndrome: a nationwide French series comparing children and adults. Clin J Am Soc Nephrol 8:554–562PubMedPubMedCentralCrossRef
5.
Campistol JM, Arias M, Ariceta G et al (2015) An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document. Nefrologia 35:421–447PubMedCrossRef
6.
Nayer A, Asif A (2016) Atypical hemolytic-uremic syndrome: a clinical review. Am J Ther 23:e151–e158PubMedCrossRef
7.
8.
Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA et al (2007) Differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol 18:2392–2400PubMedCrossRef
9.
Noris M, Caprioli J, Bresin E et al (2010) Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype. Clin J Am Soc Nephrol 5:1844–1859PubMedPubMedCentralCrossRef
10.
Geerdink LM, Westra D, van Wijk JA et al (2012) Atypical hemolytic uremic syndrome in children: complement mutations and clinical characteristics. Pediatr Nephrol 27:1283–1291PubMedPubMedCentralCrossRef
11.
Ariceta G, Besbas N, Johnson S et al (2009) Guideline for the investigation and initial therapy of diarrhea-negative hemolytic uremic syndrome. Pediatr Nephrol 24:687–696PubMedCrossRef
12.
Loirat C, Garnier A, Sellier-Leclerc AL, Kwon T (2010) Plasmatherapy in atypical hemolytic uremic syndrome. Semin Thromb Hemost 36:673–681PubMedCrossRef
13.
US Food and Drug Administration (2015) Soliris (eculizumab) [prescribing information]. Alexion Pharmaceuticals, Inc., Cheshire, CT
14.
European Medicines Agency (2015) Soliris (eculizumab) [summary of product characteristics]. Alexion Europe SAS, Paris
15.
Legendre CM, Licht C, Muus P et al (2013) Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 368:2169–2181PubMedCrossRef
16.
Licht C, Greenbaum LA, Muus P et al (2015) Efficacy and safety of eculizumab in atypical hemolytic uremic syndrome from 2-year extensions of phase 2 studies. Kidney Int 87:1061–1073PubMedPubMedCentralCrossRef
17.
Greenbaum LA, Fila M, Ardissino G et al (2016) Eculizumab is a safe and effective treatment in pediatric patients with atypical hemolytic uremic syndrome. Kidney Int 89:701–711PubMedCrossRef
18.
Fakhouri F, Hourmant M, Campistol JM et al (2016) Terminal complement inhibitor eculizumab in adult patients with atypical hemolytic uremic syndrome: a single-arm, open-label trial. Am J Kidney Dis 68:84–93PubMedCrossRef
19.
Riedl M, Fakhouri F, Le Quintrec M et al (2014) Spectrum of complement-mediated thrombotic microangiopathies: pathogenetic insights identifying novel treatment approaches. Semin Thromb Hemost 40:444–464PubMedCrossRef
20.
Kavanagh D, Goodship THJ, Richards A (2006) Atypical haemolytic uraemic syndrome. Br Med Bull 77 and 78:5–22CrossRef
21.
Akimoto T, Muto S, Ito C et al (2011) Clinical features of malignant hypertension with thrombotic microangiopathy. Clin Exp Hypertens 33:77–83PubMedCrossRef
22.
23.
Nester CM, Thomas CP (2012) Atypical hemolytic uremic syndrome: what is it, how is it diagnosed, and how is it treated? Hematology Am Soc Hematol Educ Program 2012:617–625PubMed
24.
Noris M, Mescia F, Remuzzi G (2012) STEC-HUS, atypical HUS and TTP are all diseases of complement activation. Nat Rev Nephrol 8:622–633PubMedCrossRef
25.
26.
Khanal N, Dahal S, Upadhyay S, Bhatt VR, Bierman PJ (2015) Differentiating malignant hypertension-induced thrombotic microangiopathy from thrombotic thrombocytopenic purpura. Ther Adv Hematol 6:97–102PubMedPubMedCentralCrossRef
27.
Dashe JS, Ramin SM, Cunningham FG (1998) The long-term consequences of thrombotic microangiopathy (thrombotic thrombocytopenic purpura and hemolytic uremic syndrome) in pregnancy. Obstet Gynecol 91:662–668PubMed
28.
Fakhouri F, Roumenina L, Provot F et al (2010) Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol 21e:859–867CrossRef
29.
Vaught AJ, Gavriilaki E, Hueppchen N et al (2016) Direct evidence of complement activation in HELLP syndrome: a link to atypical hemolytic uremic syndrome. Exp Hematol 44:390–398PubMedPubMedCentralCrossRef
30.
Shrivastava M, Modi G, Singh RK, Navaid S (2011) Early diagnosis and management of postpartum hemolytic uremic syndrome with plasma exchange. Transfus Apher Sci 44:257–262PubMedCrossRef
31.
32.
Calvert GD (1972) Postpartum haemolytic uraemic syndrome: case report and brief review. J Obstet Gynaecol Br Commonw 79:244–249PubMedCrossRef
33.
Delmas Y, Bordes C, Loirat C, Fremeaux-Bacchi V, Combe C (2013) Post-partum atypical haemolytic-uraemic syndrome treated with eculizumab: terminal complement activity assessment in clinical practice. Clin Kidney J 6:243–244PubMedPubMedCentralCrossRef
34.
Ardissino G, Wally Ossola M, Baffero GM, Rigotti A, Cugno M (2013) Eculizumab for atypical hemolytic uremic syndrome in pregnancy. Obstet Gynecol 122:487–489PubMedCrossRef
35.
Carr R, Cataland SR (2013) Relapse of aHUS after discontinuation of therapy with eculizumab in a patient with aHUS and factor H mutation. Ann Hematol 92:845–846PubMedCrossRef
36.
Zschiedrich S, Prager EP, Kuehn EW (2013) Successful treatment of the postpartum atypical hemolytic uremic syndrome with eculizumab. Ann Intern Med 159:76PubMedCrossRef
37.
Canigral C, Moscardo F, Castro C et al (2014) Eculizumab for the treatment of pregnancy-related atypical hemolytic uremic syndrome. Ann Hematol 93:1421–1422PubMed
38.
Mussoni MP, Veneziano FA, Boetti L, et al. (2014) Innovative therapeutic approach: sequential treatment with plasma exchange and eculizumab in a pregnant woman affected by atypical hemolytic-uremic syndrome. Transfus Apher Sci 51:134–136PubMedCrossRef
39.
De Sousa Amorim E, Blasco M, Quintana L, Sole M, de Cordoba SR, Campistol JM (2015) Eculizumab in pregnancy-associated atypical hemolytic uremic syndrome: insights for optimizing management. J Nephrol 28:641–645CrossRef
40.
41.
Tsai HM, Kuo E (2016) From gestational hypertension and preeclampsia to atypical hemolytic uremic syndrome. Obstet Gynecol 127:907–910PubMedCrossRef
42.
Kelly RJ, Hochsmann B, Szer J et al (2015) Eculizumab in pregnant patients with paroxysmal nocturnal hemoglobinuria. N Engl J Med 373:1032–1039PubMedCrossRef
43.
Hallstensen RF, Bergseth G, Foss S et al (2015) Eculizumab treatment during pregnancy does not affect the complement system activity of the newborn. Immunobiology 220:452–459PubMedCrossRef
44.
Miyasaka N, Miura O, Kawaguchi T et al (2016) Pregnancy outcomes of patients with paroxysmal nocturnal hemoglobinuria treated with eculizumab: a Japanese experience and updated review. Int J Hematol 103:703–712PubMedCrossRef
45.
Shibagaki Y, Fujita T (2005) Thrombotic microangiopathy in malignant hypertension and hemolytic uremic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP): can we differentiate one from the other? Hypertens Res 28:89–95PubMedCrossRef
46.
van den Born BJ, Honnebier UP, Koopmans RP, van Montfrans GA (2005) Microangiopathic hemolysis and renal failure in malignant hypertension. Hypertension 45:246–251PubMedCrossRef
47.
Mathew RO, Nayer A, Asif A (2016) The endothelium as the common denominator in malignant hypertension and thrombotic microangiopathy. J Am Soc Hypertens 10:352–359PubMedCrossRef
48.
49.
Farquharson CA, Struthers AD (2002) Aldosterone induces acute endothelial dysfunction in vivo in humans: evidence for an aldosterone-induced vasculopathy. Clin Sci (Lond) 103:425–431CrossRef
50.
Cachofeiro V, Miana M, de Las Heras N et al (2008) Aldosterone and the vascular system. J Steroid Biochem Mol Biol 109:331–335PubMedCrossRef
51.
van den Born BJH, Lowenberg EC, van der Hoeven NV et al (2011) Endothelial dysfunction, platelet activation, thrombogenesis and fibrinolysis in patients with hypertensive crisis. J Hypertens 29:922–927PubMedCrossRef
52.
Tsai HM (2016) Does anticomplement therapy have a role in the management of malignant hypertension? J Clin Hypertens (Greenwich) 18:359–360CrossRef
53.
Totina A, Iorember F, El-Dahr SS, Yosypiv IV (2013) Atypical hemolytic-uremic syndrome in a child presenting with malignant hypertension. Clin Pediatr (Phila) 52:183–186CrossRef
54.
55.
Zhang B, Xing C, Yu X, Sun B, Zhao X, Qian J (2008) Renal thrombotic microangiopathies induced by severe hypertension. Hypertens Res 31:479–483PubMedCrossRef
56.
Al-Akash SI, Almond PS, Savell VH Jr, Gharaybeh SI, Hogue C (2011) Eculizumab induces long-term remission in recurrent post-transplant HUS associated with C3 gene mutation. Pediatr Nephrol 26:613–619PubMedCrossRef
57.
Garjau M, Azancot M, Ramos R, Sanchez-Corral P, Montero MA, Seron D (2012) Early treatment with eculizumab in atypical haemolytic uraemic syndrome. Clin Kidney J 5:31–33PubMedPubMedCentralCrossRef
58.
Besbas N, Gulhan B, Karpman D et al (2013) Neonatal onset atypical hemolytic uremic syndrome successfully treated with eculizumab. Pediatr Nephrol 28:155–158PubMedCrossRef
59.
60.
Ohta T, Urayama K, Tada Y et al (2015) Eculizumab in the treatment of atypical hemolytic uremic syndrome in an infant leads to cessation of peritoneal dialysis and improvement of severe hypertension. Pediatr Nephrol 30:603–608PubMedCrossRef
61.
Sevinc M, Basturk T, Sahutoglu T et al (2015) Plasma resistant atypical hemolytic uremic syndrome associated with a CFH mutation treated with eculizumab: a case report. J Med Case Rep 9:92PubMedPubMedCentralCrossRef
62.
Sharma S, Pradhan M, Meyers KE, Le Palma K, Laskin BL (2015) Neonatal atypical hemolytic uremic syndrome from a factor H mutation treated with eculizumab. Clin Nephrol 84:181–185PubMedPubMedCentralCrossRef
63.
Zuber J, Fakhouri F, Roumenina LT, Loirat C, Fremeaux-Bacchi V (2012) Use of eculizumab for atypical haemolytic uraemic syndrome and C3 glomerulopathies. Nat Rev Nephrol 8:643–657PubMedCrossRef
64.
Le Quintrec M, Zuber J, Moulin B et al (2013) Complement genes strongly predict recurrence and graft outcome in adult renal transplant recipients with atypical hemolytic and uremic syndrome. Am J Transplant 13:663–675PubMedCrossRef
65.
Zuber J, Le Quintrec M, Krid S et al (2012) Eculizumab for atypical hemolytic uremic syndrome recurrence in renal transplantation. Am J Transplant 12:3337–3354PubMedCrossRef
66.
Ornstein BW, Atkinson JP, Densen P (2012) The complement system in pediatric systemic lupus erythematosus, atypical hemolytic uremic syndrome, and complocentric membranoglomerulopathies. Curr Opin Rheumatol 24:522–529PubMedCrossRef
67.
Leffler J, Bengtsson AA, Blom AM (2014) The complement system in systemic lupus erythematosus: an update. Ann Rheum Dis 73:1601–1606PubMedCrossRef
68.
Birmingham DJ, Hebert LA (2015) The complement system in lupus nephritis. Semin Nephrol 35:444–454PubMedCrossRef
69.
Zhao J, Wu H, Khosravi M et al (2011) Association of genetic variants in complement factor H and factor H-related genes with systemic lupus erythematosus susceptibility. PLoS Genet 7:e1002079PubMedPubMedCentralCrossRef
70.
Jonsen A, Nilsson SC, Ahlqvist E et al (2011) Mutations in genes encoding complement inhibitors CD46 and CFH affect the age at nephritis onset in patients with systemic lupus erythematosus. Arthritis Res Ther 13:R206PubMedPubMedCentralCrossRef
71.
Chen MH, Chen MH, Chen WS et al (2011) Thrombotic microangiopathy in systemic lupus erythematosus: a cohort study in North Taiwan. Rheumatology (Oxford) 50:768–775CrossRef
72.
Bridoux F, Vrtovsnik F, Noel C et al (1998) Renal thrombotic microangiopathy in systemic lupus erythematosus: clinical correlations and long-term renal survival. Nephrol Dial Transplant 13:298–304PubMedCrossRef
73.
74.
Musio F, Bohen EM, Yuan CM, Welch PG (1998) Review of thrombotic thrombocytopenic purpura in the setting of systemic lupus erythematosus. Semin Arthritis Rheum 28:1–19PubMedCrossRef
75.
Banfi G, Bertani T, Boeri V et al (1991) Renal vascular lesions as a marker of poor prognosis in patients with lupus nephritis. Gruppo Italiano per lo Studio della Nefrite Lupica (GISNEL). Am J Kidney Dis 18:240–248PubMedCrossRef
76.
Jain R, Chartash E, Susin M, Furie R (1994) Systemic lupus erythematosus complicated by thrombotic microangiopathy. Semin Arthritis Rheum 24:173–182PubMedCrossRef
77.
Giannouli S, Voulgarelis M, Ziakas PD, Tzioufas AG (2006) Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Ann Rheum Dis 65:144–148PubMedCrossRef
78.
Samson M, Audia S, Leguy V et al (2012) Haemolytic-uraemic syndrome during severe lupus nephritis: efficacy of plasma exchange. Intern Med J 42:95–98PubMedCrossRef
79.
Coppo R, Peruzzi L, Amore A et al (2015) Dramatic effects of eculizumab in a child with diffuse proliferative lupus nephritis resistant to conventional therapy. Pediatr Nephrol 30:167–172PubMedCrossRef
80.
El-Husseini A, Hannan S, Awad A, Jennings S, Cornea V, Sawaya BP (2015) Thrombotic microangiopathy in systemic lupus erythematosus: efficacy of eculizumab. Am J Kidney Dis 65:127–130PubMedCrossRef
81.
Ramachandran R, Sakhuja V, Jha V, Kohli HS, Rathi M (2012) Plasmapheresis in systemic lupus erythematosus with thrombotic microangiopathy. Intern Med J 42:734PubMedCrossRef
82.
Gharbi C, Bourry E, Rouvier P et al (2010) Rapidly progressive lupus nephritis and concomitant thrombotic microangiopathy. Clin Exp Nephrol 14:487–491PubMedCrossRef
83.
Hadaya K, Ferrari-Lacraz S, Fumeaux D et al (2011) Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation. Am J Transplant 11:2523–2527PubMedCrossRef
84.
Stratta P, Besso L, Ferrero S et al (1996) Scleroderma renal crisis is still a life-threatening syndrome. Ren Fail 18:567–574PubMedCrossRef
85.
Zwettler U, Andrassy K, Waldherr R, Ritz E (1993) Scleroderma renal crisis as a presenting feature in the absence of skin involvement. Am J Kidney Dis 22:53–56PubMedCrossRef
86.
Yamanaka K, Mizutani H, Hashimoto K, Nishii M, Shimizu M (1997) Scleroderma renal crisis complicated by hemolytic uremic syndrome in a case of elderly onset systemic sclerosis. J Dermatol 24:184–188PubMedCrossRef
87.
Ricker DM, Sharma HM, Nahman NS Jr (1989) Acute renal failure with glomerular thrombosis in a patient with chronic scleroderma. Am J Kidney Dis 14:524–526PubMedCrossRef
88.
Meyrier A, Becquemont L, Weill B, Callard P, Rainfray M (1991) Hemolytic-uremic syndrome with anticardiolipin antibodies revealing paraneoplastic systemic scleroderma. Nephron 59:493–496PubMedCrossRef
89.
Haviv YS, Safadi R (1998) Normotensive scleroderma renal crisis: case report and review of the literature. Ren Fail 20:733–736PubMedCrossRef
90.
Chen WS, Young AH, Wang HP, Huang DF (2009) Hemolytic uremic syndrome with ischemic glomerulonephropathy and obliterative vasculopathy in a systemic sclerosis patient treated with cyclosporine-A. Rheumatol Int 29:821–824PubMedCrossRef
91.
Thomas CP, Nester CM, Phan AC, Sharma M, Steele AL, Lenert PS (2015) Eculizumab for rescue of thrombotic microangiopathy in PM-Scl antibody-positive autoimmune overlap syndrome. Clin Kidney J 8:698–701PubMedPubMedCentralCrossRef
92.
Craner GE, Burdick GE (1976) Acute colitis resembling ulcerative colitis in the hemolytic-uremic syndrome. Am J Dig Dis 21:74–76PubMedCrossRef
93.
Ahrenstedt O, Knutson L, Nilsson B, Nilsson-Ekdahl K, Odlind B, Hallgren R (1990) Enhanced local production of complement components in the small intestines of patients with Crohn’s disease. N Engl J Med 322:1345–1349PubMedCrossRef
94.
Sugihara T, Kobori A, Imaeda H et al (2010) The increased mucosal mRNA expressions of complement C3 and interleukin-17 in inflammatory bowel disease. Clin Exp Immunol 160:386–393PubMedPubMedCentralCrossRef
95.
Halstensen TS, Mollnes TE, Garred P, Fausa O, Brandtzaeg P (1992) Surface epithelium related activation of complement differs in Crohn’s disease and ulcerative colitis. Gut 33:902–908PubMedPubMedCentralCrossRef
96.
Green H, Harari E, Davidovits M et al (2014) Atypical HUS due to factor H antibodies in an adult patient successfully treated with eculizumab. Ren Fail 36:1119–1121PubMedCrossRef
97.
Webb TN, Griffiths H, Miyashita Y et al (2015) Atypical hemolytic uremic syndrome and chronic ulcerative colitis treated with eculizumab. Int J Med Pharm Case Reports 4:105–112PubMedPubMedCentralCrossRef
98.
Al-Nouri ZL, Reese JA, Terrell DR, Vesely SK, George JN (2015) Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood 125:616–618PubMedPubMedCentralCrossRef
99.
Reese JA, Bougie DW, Curtis BR et al (2015) Drug-induced thrombotic microangiopathy: experience of the Oklahoma registry and the BloodCenter of Wisconsin. Am J Hematol 90:406–410PubMedPubMedCentralCrossRef
100.
Izzedine H, Perazella MA (2015) Thrombotic microangiopathy, cancer, and cancer drugs. Am J Kidney Dis 66:857–868PubMedCrossRef
101.
102.
Pisoni R, Ruggenenti P, Remuzzi G (2001) Drug-induced thrombotic microangiopathy: incidence, prevention and management. Drug Saf 24:491–501PubMedCrossRef
103.
104.
Safa K, Logan MS, Batal I, Gabardi S, Rennke HG, Abdi R (2015) Eculizumab for drug-induced de novo posttransplantation thrombotic microangiopathy: a case report. Clin Nephrol 83:125–129PubMedCrossRef
105.
Nurnberger J, Philipp T, Witzke O et al (2009) Eculizumab for atypical hemolytic-uremic syndrome. N Engl J Med 360:542–544PubMedCrossRef
106.
Starck M, Wendtner CM (2014) Use of eculizumab in refractory gemcitabine-induced thrombotic microangiopathy. Br J Haematol 164:894–896CrossRef
107.
Noris M, Remuzzi G (2013) Managing and preventing atypical hemolytic uremic syndrome recurrence after kidney transplantation. Curr Opin Nephrol Hypertens 22:704–712PubMedCrossRef
108.
Loirat C, Fakhouri F, Ariceta G et al (2016) An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol 31:15–39PubMedCrossRef
Metadata
Title
Atypical hemolytic uremic syndrome in the setting of complement-amplifying conditions: case reports and a review of the evidence for treatment with eculizumab
Authors
Arif Asif
Ali Nayer
Christian S. Haas
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 3/2017
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-016-0357-7

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