Although the efficacy of medicines in clinical trials is generally well demonstrated, their effectiveness in clinical practice is strongly influenced by patient adherence. Furthermore, Nonadherence poses a great challenge in neuropathic pain (NeP) management. 

Pregabalin dose titration helps to achieve the optimal balance between efficacy and tolerability. The prescribing information suggests that pregabalin should be started at 150 mg/day, which may be increased to 300 mg/day within one week. This dose may be further increased depending on the indication. Evidence indicates an association between dose titration and improved pain relief. 

A recent study thus examined pregabalin dose titration and its impact on treatment adherence and duration in patients with neuropathic pain (NeP).

This study employed the MarketScan database (2009–2014) to extract a cohort of incident adult pregabalin users with NeP (with at least 12 months of follow-up data). Any dose augmentation within 45 days of first pregabalin administration was defined as dose titration. Adherence (calculated by medication possession ratio/MPR) and persistence (calculated as the duration of continuous treatment) were compared between the cohorts with and without dose titration. 

The results showed that among the 5,186 patients, only 18% experienced dose titration; and this subset of the patient was ~2.6 times more likely to be adherent to the treatment than those without dose titration. Also, the time to discontinuation or switch was found to be markedly longer among patients who had dose titration than those without dose titration (4.99 vs. 4.04 months).

Thus, pregabalin dose titration improves treatment adherence and persistence among NeP patients. 

Also, physicians must be aware of dose recommendations in the prescribing information and educate patients about the importance of titration and adherence.

PLoS ONE 16(1): e0242467. https://doi.org/10.1371/journal.pone.0242467