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Adherence to growth hormone therapy: results of a multicenter study
Banu Küçükemre Aydın1, Zehra Aycan2, Zeynep Sıklar3
1Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Insights
Poor adherence to growth hormone (GH) therapy is common in children and leads to suboptimal growth. Ensuring good adherence is crucial before investigating other growth-affecting factors.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Patient Adherence
Background:
- Growth hormone (GH) therapy is vital for children with growth deficiencies.
- Assessing adherence and its impact on treatment outcomes is essential.
Purpose of the Study:
- To evaluate adherence to GH therapy in children.
- To identify factors influencing adherence and its effect on growth outcomes.
Main Methods:
- 217 GH-naïve pediatric patients were monitored over 12 months.
- Adherence was categorized (excellent, good, fair, poor) based on omitted doses.
- Growth velocity and IGF-1 SDS were assessed.
Main Results:
- GH therapy adherence decreased over time.
- Excellent/good adherence correlated with better growth velocity and IGF-1 SDS.
- Boys showed better adherence than girls.
Conclusions:
- Suboptimal growth during GH therapy is often linked to poor adherence.
- Clinicians must verify patient adherence before exploring other growth issues.
Objective:
To evaluate the adherence to growth hormone (GH) therapy and identify the influencing factors and outcomes in children.
Methods:
A total of 217 GH-naïve patients in 6 pediatric endocrinology clinics were enrolled in the study. Structured questionnaires were filled out and patients were evaluated at the initiation and 3rd, 6th, and 12th months of therapy. Patients were categorized into 4 adherence segments based on percentage of doses omitted at each evaluation period, classified as excellent if 0%, good if 5%, fair if 5 to 10%, and poor if > 10%.
Results:
There was a decrement in adherence to GH therapy during the study period (P = .006). Patients who showed excellent and good adherence to therapy had better growth velocity and growth velocity standard deviation scores (SDSs) (P = .014 and P = .015, respectively). A negative correlation between growth velocity SDS and number of missed injections was also observed (r = -.412; P = .007). A positive correlation between delta insulin-like growth factor-1 (IGF-1) SDS and growth velocity was demonstrated (r = .239; P = .042). IGF-1 levels were significantly higher in patients who showed excellent and good adherence to therapy (P = .01). Adherence was better in boys than in girls (P = .035), but adherence rates were not associated with age, cause of GH treatment, socioeconomic status, person who administered the injections, type of injection device, or GH product.
Conclusion:
Poor adherence to GH therapy was common in our group of patients and was one of the factors underlying suboptimal growth during therapy. Before considering other problems that can affect growth, clinicians should confirm good adherence to therapy.
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