ATHENA

Does taking amitriptyline tablets soon after the onset of shingles rash prevent post-herptic neuralgia?

Background: Approximately 30% of people get Herpes Zoster or “shingles'' and it is more common in people over the age of 50. The most common complication of shingles is post-herpetic neuralgia, which can be disabling for months-to-years. The early administration of antivirals (within 72 hours of rash onset but up to 1 week) reduces the acute pain of HZ but has never been shown to reduce the incidence of post-herpetic neuralgia. Other attempts to prevent post-herpetic neuralgia have proved ineffective.

ATHENA aims to compare the clinical and cost effectiveness of low dose amitriptyline to placebo for the prevention of post-herpetic neuralgia at 90 days.

Guidance notes for conducting searches (supplied by Banbury Cross Health Centre):

1) ATHENA patient invitation pop-up_BCHC_version

This is our modified version of the pop-up supplied by OneCare and is for a situation where all clinicians in a practice may be identifying eligible patients but only one or two staff are trained to do the ATHENA screening. It still adds the code to the patient record when triggered that is counted by the OneCare search provided by the study team so the monthly returns will be accurate. The pop-up gives staff a script to read and they click to say if the patient is interested to take part or not and will then add an appropriate code to the patient record. This protocol needs to be setup with the triggers as outlined by the study team for the original OneCare pop-up protocol

2) ATHENA BCHC searches

This is the set of searches which identifies all patients with an ATHENA code and puts them into a search output based on their most recent code:

• Interested in taking part and needs screening

• Screening completed and awaiting consent and randomisation by study team

• Consented to study

• Failed screening

• Declined to take part

A member of the research team can run these searches once or twice a day and let the Athena trained practice staff know if there is anybody in the ‘needs screening’ search to act on.

3) ATHENA BCHC Research Team Protocol

This protocol can be added to the F12 shortcuts in EMIS and allows practice research staff to quickly update a patient’s coding in just a couple of clicks. It also has a quick link to access the online screening website for any staff trained in screening.

4) Amitriptyline – ATHENA

This is a safety pop-up protocol which needs to be setup with a trigger to run if a ‘Tricyclic and Related Antidepressant Drug’ is issued. It will trigger a warning if somebody tries to issue a TCA prescription to a patient who is consented to take part in the study as the practice team are blinded.

If you experience any problems downloading the information, please contact joanne.carter@nihr.ac.uk who is acting as lead facilitator for this study.  

Disclaimer:

Please note the resources provided are designed to assist with the identification of potentially suitable patients and to appropriately code these patient if required.

These resources have been developed based on the criteria provided by the relevant study team and whilst every effort has been made to make them universally implementable they rely on read codes and the data stored in the individual practice's clinical system. These resources are intended to assist with identification but should be used in conjunction with clinical oversight and a clear understanding of the study parameters.

While we endeavour to keep the information, tools and resources provided up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the tools provided for any purpose. Any reliance you place on such information is therefore strictly at your own risk.

In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from loss of data or profits arising out of, or in connection with, the use of the tools provided.