Top

Drugs & Aging

Published in:

01-01-2007 | Therapy In Practice

Post-Herpetic Neuralgia in Older Adults

Evidence-Based Approaches to Clinical Management

Authors: Paul J. Christo, Greg Hobelmann, David N. Maine

Published in: Drugs & Aging | Issue 1/2007

Abstract

Many individuals across the globe have been exposed to the varicella-zoster virus (VZV) that causes chickenpox. After chickenpox has resolved, the virus remains latent in the dorsal root ganglia where it can re-emerge later in life as herpes zoster, otherwise known as shingles. Herpes zoster is a transient disease characterised by a dermatomal rash that is usually associated with significant pain. Post-herpetic neuralgia (PHN) is the term used for the condition that exists if the pain persists after the rash has resolved. Advanced age and compromised cell-mediated immunity are significant risk factors for reactivation of herpes zoster and the subsequent development of PHN. Though the pathophysiology of PHN is unclear, studies suggest peripheral and central demyelination as well as neuronal destruction are involved.

Both the vaccine against VZV (Varivax®) and the newly released vaccine against herpes zoster (Zostavax®) may lead to substantial reductions in morbidity from herpes zoster and PHN. In addition, current evidence suggests that multiple medications are effective in reducing the pain associated with PHN. These include tricyclic antidepressants, antiepileptics, Opioids, NMDA receptor antagonists as well as topical lidocaine (lignocaine) and capsaicin. Reasonable evidence supports the use of intrathecal corticosteroids, but the potential for neurological sequelae should prompt caution with their application. Epidural corticosteroids have not been shown to provide effective analgesia for PHN. Sympathetic blockade may assist in treating the pain of herpes zoster or PHN. For intractable PHN pain, practitioners have performed delicate surgeries and attempted novel therapies. Although such therapies may help reduce pain, they have been associated with disappointing results, with up to 50% of patients failing to receive acceptable pain relief. Hence, it is likely that the most effective future treatment for this disease will focus on prevention of VZV infection and immunisation against herpes zoster infection with a novel vaccine.

The use of trade names is for product identification purposes only and does not imply endorsement.

Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother 2004; 5(3): 551–9PubMedCrossRef

Douglas MW, Johnson RW, Cunningham AL. Tolerability of treatments for postherpetic neuralgia. Drug Saf 2004; 27(15): 1217–33PubMedCrossRef

Johnson RW, Dworkin RH. Treatment of herpes zoster and postherpetic neuralgia. BMJ 2003; 326(7392): 748–50PubMedCrossRef

Kinsella K, Velkoff VA. An aging world. Washington, DC: US Census Bureau: US Government Printing Office, 2001

Dworkin RH, Schmaker KE. The epidemiology and natural history of herpes zoster and postherpetic neuralgia. Pain Res Clin Manag 2001; 5: 39–64

Panlilio LM, Christo PJ, Raja SN. Current management of postherpetic neuralgia. Neurologist 2002; 8(6): 339–50PubMedCrossRef

Menke JJ, Heins JR. Treatment of postherpetic neuralgia. J Am Pharm Assoc (Wash) 1999; 39(2): 217–21

Adams RD, Victor M, Ropper AH. Principles of neurology. New York: McGraw-Hill, 1997: 756–759

Raja SN, Haythornthwaite JA, Pappagallo M, et al. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2002; 59(7): 1015–21PubMedCrossRef

10.

Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998; 50(6): 1837–41PubMedCrossRef

11.

Eide PK, Jorum E, Stubhaug A, et al. Relief of post-herpetic neuralgia with the N-methyl-D-aspartic acid receptor antagonist ketamine: a double-blind, cross-over comparison with morphine and placebo. Pain 1994; 58(3): 347–54PubMedCrossRef

12.

Weinberg JM, Scheinfeld NS. Cutaneous infections in the elderly: diagnosis and management. Dermatol Ther 2003; 16(3): 195–205PubMedCrossRef

13.

Watson CP, Watt VR, Chipman M, et al. The prognosis with postherpetic neuralgia. Pain 1991. 46(2): 195–9PubMedCrossRef

14.

Oaklander AL. The density of remaining nerve endings in human skin with and without postherpetic neuralgia after shingles. Pain 2001; 92(1–2): 139–45PubMedCrossRef

15.

Baron R. Peripheral neuropathic pain: from mechanisms to symptoms. Clin J Pain 2000; 16 (2 Suppl.): s12–20PubMedCrossRef

16.

Petersen KL, Fields H, Brennum J, et al. Capsaicin evoked pain and allodynia in postherpetic neuralgia. Pain 2000; 88: 125–33PubMedCrossRef

17.

Rowbotham MC, Petersen KL, Fields HL. Is postherpetic neuralgia more than one disorder? Pain Forum 1998; 7: 231–7CrossRef

18.

Watson CP. The treatment of neuropathic pain: antidepressants and Opioids. Clin J Pain 2000; 16 (2 Suppl.): S49–55PubMedCrossRef

19.

Bonica JJ. History of pain concepts and therapies. In: Bonica JJ, editor. The management of pain. Philadelphia (PA): Lea and Feabiger, 1990: 2–18

20.

Levin MJ, Smith JG, Kaufhold RM, et al. Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. J Infect Dis 2003; 188(9): 1336–44PubMedCrossRef

21.

Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352(22): 2271–84PubMedCrossRef

22.

Tyring SK. Efficacy of famciclovir in the treatment of herpes zoster. Semin Dermatol 1996; 15 (2 Suppl. 1): 27–31PubMed

23.

Tyring S, Barbarash RA, Nahlik JE, et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Ann Intern Med 1995; 123(2): 89–96PubMed

24.

Shafran SD, Tyring SK, Ashton R, et al. Once, twice, or three times daily famciclovir compared with aciclovir for the oral treatment of herpes zoster in immunocompetent adults: a randomized, multicenter, double-blind clinical trial. J Clin Virol 2004; 29(4): 248–53PubMedCrossRef

25.

Beutner KR, Friedman DJ, Forszpaniak C, et al. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995 Jul; 39(7): 1546–53PubMedCrossRef

26.

Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of vala-cyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000 Sep–Oct; 9(9): 863–9PubMedCrossRef

27.

Gnann JW Jr, Whitley RJ. Clinical practice: herpes zoster. N Engl J Med 2002 Aug 1; 347(5): 340–6PubMedCrossRef

28.

Wood J, Shukla S, Fiddian AP, et al. Treatment of acute herpes zoster: effect of early (<48 hrs) versus late (48–72 hrs) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis 1998; 178 Suppl. 1: S81–4PubMedCrossRef

29.

Decroix J, Partsch H, Gonzalez R, et al. Factors influencing pain outcome in herpes zoster: an observational study with valaciclovir. J Eur Acad Dermatol Venereol 2000; 14: 23–33PubMedCrossRef

30.

Whitley RJ, Weiss H, Gnann JW Jr, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med 1996; 125(5): 376–83PubMed

31.

Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 1994; 330(13): 896–900PubMedCrossRef

32.

Baldessarini R. Drug therapy of depression and anxiety disorders. In: Brunton LJ, Parker KL, editors. Goodman and Gilman’s pharmacological basis of therapeutics. New York: McGraw-Hill, 2006: 438–450

33.

Freynhagen R, Strojek K, Griesing T, et al. Efficacy of pre-gabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005; 115(3): 254–63PubMedCrossRef

34.

Hempenstall K, Nurmikko TJ, Johnson RW, et al. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLoS Med 2005; 2: el64CrossRef

35.

Boureau F, Legallicier P, Kabir-Ahmadi M. Tramadol in postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Pain 2003; 104(1–2): 323–31PubMedCrossRef

36.

Meier T, Wasner G, Faust M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomised, double-blind, placebo-controlled study. Pain 2003; 106: 151–8PubMedCrossRef

37.

Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 1989; 21 (2 Pt 1): 265–70PubMedCrossRef

38.

Collins SL, Moore RA, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. J Pain Symptom Manage 2000; 20(6): 449–58PubMedCrossRef

39.

Watson CP, Vernich L, Chipman M, et al. Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Neurology 1998; 51(4): 1166–71PubMedCrossRef

40.

Ahmad M, Goucke CR. Management strategies for the treatment of neuropathic pain in the elderly. Drugs Aging 2002; 19(12): 929–45PubMedCrossRef

41.

Vieweg WV, Wood MA. Tricyclic antidepressants, QT interval prolongation, and torsade de pointes. Psychosomatics 2004; 45(5): 371–7PubMedCrossRef

42.

Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997; 73: 123–39PubMedCrossRef

43.

Potter WZ, Rudorfer MV, Manji H. The pharmacologic treatment of depression. N Engl J Med 1991 Aug 29; 325(9): 633–42PubMedCrossRef

44.

McNamara J. Pharmacotherapy of the epilepsies. In: Brunton LJ, Parker KL, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. New York: McGraw-Hill, 2006: 517–518

45.

Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280(21): 1837–42PubMedCrossRef

46.

Rice AS, Maton S. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001; 94(2): 215–24PubMedCrossRef

47.

Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs 2005; 65(1): 111–8PubMedCrossRef

48.

Dworkin RH, Corbin AE, Young JP Jr, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2003; 60(8): 1274–83PubMedCrossRef

49.

Sabatowski R, Galvez R, Cherry DA, et al., the 1008-045 Study Group. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomized, placebo-controlled clinical trial. Pain 2004; 109: 26–35PubMedCrossRef

50.

Max MB, Schafer SC, Culnane M, et al. Association of pain relief with drug side effects in postherpetic neuralgia; a single dose study of Clonidine, codeine, ibuprofen and placebo. Clin Pharmacol Ther 1988; 43: 363–71PubMedCrossRef

51.

Rowbotham MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology 1991; 41(7): 1024–8PubMedCrossRef

52.

Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of Opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA 2005; 293(24): 3043–52PubMedCrossRef

53.

Rowbotham MC, Twilling L, Davies PS, et al. Oral Opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med 2003; 348(13): 1223–32PubMedCrossRef

54.

Lewis JW, Husbands SM. The orvinols and related Opioids—high affinity ligands with diverse efficacy profiles. Curr Pharm Des 2004; 10(7): 717–32PubMedCrossRef

55.

Cowan A, Lewis JW, Macfarlane IR. Agonist and antagonist properties of buprenorphine, a new antinociceptive agent. Br J Pharmacol 1977; 60: 537–45PubMedCrossRef

56.

Lee K, Akil H, Woods JH, et al. Differential binding properties of oripavines at cloned mu and delta Opioid receptors. Eur J Pharmacol 1999; 378: 323–30PubMedCrossRef

57.

Likar R, Sittl R. Transdermal buprenorphine for treating nociceptive and neuropathic pain: four case studies. Anesth Analg 2005; 100: 781–5PubMedCrossRef

58.

Likar R, Kayser H, Sittl R. Long term management of chronic pain with transdermal buprenorphine: a multicenter, open-label, follow up study in patients from three short-term clinical trials. Clin Ther 2006; 28: 943–52PubMedCrossRef

59.

Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352(13): 1324–34PubMedCrossRef

60.

Bulka A, et al. Reduced tolerance to the anti-hyperalgesic effect of methadone in comparison to morphine in a rat model of mononeuropathy. Pain 2002; 95(1–2): 103–9PubMedCrossRef

61.

Davis AM, Inturrisi CE. d-Methadone blocks morphine tolerance and N-methyl-D-aspartate-induced hyperalgesia. J Pharmacol Exp Ther 1999; 289(2): 1048–53PubMed

62.

Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med 2003; 349(20): 1943–53PubMedCrossRef

63.

Rushton ARA, Sneyd JR. Opioid analgesics. Br J Hosp Med 1997; 57: 105–6PubMed

64.

Raffa RB. A novel approach to the pharmacology of analgesics. Am J Med 1996; 101Suppl. 1A: 40S–46SPubMed

65.

Minto CF, Power I. New Opioid analgesics: an update. Int Anesthesiol Clin 1997; 35: 49–65PubMedCrossRef

66.

Aronson MD. Nonsteroidal anti-inflammatory drugs, traditional Opioids, and tramadol: contrasting therapies for the treatment of chronic pain. Clin Ther 1997; 19: 420–32PubMedCrossRef

67.

Duthie DJR. Remifentanil and tramadol. Br J Anaesth 1998; 81: 51–7PubMedCrossRef

68.

Harati Y, Gooch C, Swenson M, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology 1998; 50(6): 1842–6PubMedCrossRef

69.

Gobel H, Stadler T. Treatment of post-herpes zoster pain with tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine. Drugs 1997; 53Suppl. 2: 34–9PubMedCrossRef

70.

Dalgin P. Use of tramadol in chronic pain. Clin Geriatrics 1995; 3: 1–6

71.

Bamigbade TA, Langford RM. Tramadol hydrochloride: an overview of current use. Hosp Med 1998; 59(5): 373–6PubMed

72.

Schug SA, Dickenson AH, Straugurger W, et al. Current concepts on the mechanisms of action of tramadol [abstract]. 9th World Congress on Pain; 1999 Aug 22–27; Vienna

73.

Shipton EA. Tramadol: present and future. Anaesth Intensive Care 2000; 28(4): 363–74PubMed

74.

Gana TJ, Pascual ML, Fleming RR, et al. Extended-release tramadol in the treatment of Osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Curr Med Res Opin 2006; 22(7): 1391–401PubMedCrossRef

75.

Grond S, Zech D, Lynch J, et al. Tramadol: a weak Opioid for relief of cancer pain. Pain Clin 1992; 5: 241

76.

Cossmann M, Wilsmann KM. Behandlung langer andauernder Schmerzsyndrome: Beurteilung der Wirkung und Vertraglichkeit von Tramadol (Tramal) bei mehrmaliger Gabe. Munch Med Wochenschr 1987; 129: 851

77.

Cossmann M, Wilsmann KM. Effects and side-effects of tramadol: an open phase IV study with 7198 patients. Therapiewoche 1987; 37: 3475–85

78.

Bartlett D. Serotonin syndrome: a subtle toxicity. J Emerg Nurs 2006; 32(3): 277–9PubMedCrossRef

79.

Davies PS, Galer BS. Review of lidocaine patch 5% studies in the treatment of postherpetic neuralgia. Drugs 2004; 64(9): 937–47PubMedCrossRef

80.

Rowbotham MC, Davies PS, Verkempinck C, et al. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain 1996; 65(1): 39–44PubMedCrossRef

81.

Galer BS, Rowbotham MC, Perander J, et al. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 1999; 80(3): 533–8PubMedCrossRef

82.

Galer BS, Jensen MP, Ma T, et al. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the Neuropathic Pain Scale. Clin J Pain 2002; 18(5): 297–301PubMedCrossRef

83.

Rowbotham MC, Davies PS, Fields HL. Topical lidocaine gel relieves postherpetic neuralgia. Ann Neurol 1995; 37(2): 246–53PubMedCrossRef

84.

Attal N, Brasseur L, Chauvin M, et al. Effects of single and repeated applications of a eutectic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in postherpetic neuralgia. Pain 1999; 81(1–2): 203–9PubMedCrossRef

85.

Endo Pharmaceuticals Inc. Lidoderm® (lidocaine patch 5%) prescribing information. Chadds Ford (PA): Endo Pharmaceuticals Inc., 2000

86.

Gimbel J, Moskowitz M, Hines R, et al. Lidocaine patch 5% effectively treats common pain qualities reported by patients with acute, subacute, and chronic low back pain [abstract]. Fifth International Conference on Mechanisms and Treatment of Neuropathic Pain; 2002 Nov 21–23, Southhampton, Bermuda

87.

Burch F, Codding C, Patel N, et al. Effectiveness and safely of the lidocaine patch 5% as add on or monotherapy in patients with pain and Osteoarthritis; a prospective, open-label, multi-center study [abstract]. Fifth International Conference on the Mechanisms and Treatment of Neuropathic Pain; 2002 Nov 21–23, Southhampton, Bermuda

88.

Lincoff NS, Rath PP, Hirano M. The treatment of periocular and facial pain with topical capsaicin. J Neuroophthalmol 1998; 18(1): 17–20PubMedCrossRef

89.

Rumsfield JA, West DP. Topical capsaicin in dermatologie and peripheral pain disorders. DICP 1991; 25(4): 381–7PubMed

90.

Fusco BM, Giacovazzo M. Peppers and pain: the promise of capsaicin. Drugs 1997; 53(6): 909–14PubMedCrossRef

91.

Nolano M, Simone DA, Wendelschafer-Crabb G, et al. Topical capsaicin in humans: parallel loss of epidermal nerve fibers and pain sensation. Pain 1999; 81(1–2): 135–45PubMedCrossRef

92.

Watson CP, Tyler KL, Bickers DR, et al. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993; 15(3): 510–26PubMed

93.

Parsons CG. NMDA receptors as targets for drug action in neuropathic pain. Eur J Pharmacol 2001; 429: 71–8PubMedCrossRef

94.

Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Anaig 2004; 99(2): 510–20CrossRef

95.

Eide K, Stubhaug A, Oye I, et al. Continuous subcutaneous administration of the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine in the treatment of post-herpetic neuralgia. Pain 1995; 61(2): 221–8PubMedCrossRef

96.

Quan D, Wellish M, Gilden DH. Topical ketamine treatment of postherpetic neuralgia. Neurology 2003; 60(8): 1391–2PubMedCrossRef

97.

Klepstad P, Borchgrevink PC. Four years’ treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia. Acta Anaesthesiol Scand 1997; 41(3): 422–6PubMedCrossRef

98.

Hoffmann V, Coppejans H, Vercauteren M, et al. Successful treatment of postherpetic neuralgia with oral ketamine. Clin J Pain 1994; 10(3): 240–2PubMedCrossRef

99.

Kotani N, Kushikata T, Hashimoto H, et al. Intrathecal methyl-prednisolone for intractable postherpetic neuralgia. N Engl J Med 2000; 343(21): 1514–9PubMedCrossRef

100.

Nelson DA. Intraspinal therapy using methylprednisolone acetate: twenty-three years of clinical controversy. Spine 1993; 18(2): 278–86PubMedCrossRef

101.

Abram SE. Intrathecal Steroid injection for postherpetic neuralgia: what are the risks? Reg Anesth Pain Med 1999; 24(4): 283–5PubMedCrossRef

102.

Kikuchi A, Kotani N, Sato T, et al. Comparative therapeutic evaluation of intrathecal versus epidural methylprednisolone for long-term analgesia in patients with intractable postherpetic neuralgia. Reg Anesth Pain Med 1999; 24(4): 287–93PubMed

103.

Wu CL, Marsh A, Dworkin RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain 2000; 87(2): 121–9PubMedCrossRef

104.

Opstelten W, van Wijck AJ, Stoiker RJ. Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniques. Pain 2004; 107(3): 202–6PubMedCrossRef

105.

Loeser J. Surgery for postherpetic neuralgia. In: Watson CP, editor. Herpes zoster and postherpetic neuralgia. Amsterdam: Elsevier, 1993: 221–37

106.

Meglio M, Cioni B, Prezioso A, et al. Spinal cord stimulation (SCS) in the treatment of postherpetic pain. Acta Neurochir Suppl (Wien) 1989; 46: 65–6CrossRef

107.

Harke H, Gretenkort P, Ladleif HU, et al. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Anesth Anaig 2002; 94(3): 694–700CrossRef

Title: Post-Herpetic Neuralgia in Older Adults
Evidence-Based Approaches to Clinical Management
Authors: Paul J. Christo
Greg Hobelmann
David N. Maine
Publication date: 01-01-2007
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 1/2007
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200724010-00001

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2007

Management of Gout in Older Adults

Effects of Statins on Cognitive Function in Patients with Alzheimer’s Disease in Galantamine Clinical Trials

Elderly Medical Patients Treated with Prophylactic Dosages of Enoxaparin

Gerontology Forum

Patient Adherence to Osteoporosis Medications

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials