Sustained treatment with effective doses of cholinesterase inhibitors or memantine is crucial to transfer treatment effects in dementia. Numerous studies, with often small samples sizes, describe low adherence rates. The purpose of current study was to examine the medical adherence of antidementia therapy in Austria. We analyzed the data of 10 Austrian Health Insurance Funds, including treatment-naive dementia patients. Study outcome measures were discontinuation, switching, number of days on therapy, Medication-Possession-Ratio, and compliance. A total of 15,809 patients (mean age: 79.9 y, female: 67.3%) met the study's inclusion criteria. After stratification by index medication there were 40.3% on donepezil (n=6371); 26.6% on rivastigmine (n=4206); 15.3% on galantamine (n=2424); and 17.8% on memantine (n=2808). After 6 and 12 months on therapy, 5376 (34.0%) and 9243 (58.5%) patients stopped the initially prescribed antidementia therapy; after 12 months the highest discontinuation rate was seen for patients taking rivastigmine (67.3%), whereas patients on memantine (45.0%) had the lowest. After 12 months, a total of 1874 (11.9%) patients switched from their index medication to another cholinesterase inhibitor or memantine. A total of 6163 patients (39.0%) were compliant (Medication-Possession-Ratio >80%) during the first 6 months and 5366 patients (33.9%) during 12 months of the study. Our study shows that memantine-treated patients adhere significantly better to treatment. Specifically, after 12 months, 45.0% discontinued medication, 7.9% switched, and 50.8% of patients on therapy were compliant.

This observational study examined the outcome of two different therapeutic strategies in the treatment of chronic neuropathic pain by including pregabalin (PGB) as mono- or add-on therapy in one of two treatment options. Patients with a pain score of > or =4, refractory to usual care for neuropathic pain for at least 6 months, were allocated consecutively to one of two treatment strategies according to the decision of the physician: complete switch to a flexible-dosage, monotherapeutic or add-on therapy with pregabalin (PGB group), or change established doses and combinations of pre-existing mono- or combination therapy without pregabalin (non-PGB group). After 4 weeks (primary endpoint) a significant improvement in pain reduction was documented in both intention-to treat (ITT) analysis (PGB group, n = 85: mean pain score reduction of 3.53, SD 2.03, p < 0.001; non-PGB group, n = 102; mean pain score reduction of 2.83, SD 2.23, p < 0.001) and per-protocol (PP) analysis (PGB group, n = 79: mean pain score reduction 3.53 vs. 2.83, p < 0.05; non-PGB group, n = 81; 3.5 vs. 2.9, p < 0.05) compared to baseline. Comparison of the results observed in the two groups shows that patients in the PGB group achieved significantly greater pain reduction. These results demonstrate that PGB administered twice daily is superior to treatment regimes without PGB in reducing pain and pain-related interference in quality of life.

The results provide Class IV evidence that oral B. serrata reduces the intensity and frequency of headaches in patients with CCH.

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