Adherence to Growth Hormone Therapy: Results of a Multicenter Study

Background: One of the main concerns in chronic diseases such as growth hormone (GH) deficiency is adherence to the treatment, which significantly affects treatment outcomes. Methods: This cross-sectional study was conducted among 169 GH recipient children (2-12 years) and teens (13-19 years) referred to a GH distributing teaching pharmacy. The eight-item Morisky Medication Adherence Scale (MMAS) and auto-compliance method were used for the assessment of patients' adherence to GH. The potential barriers to GH therapy adherence and medication persistence were also explored. Results: Based on the MMAS method, 56.7% of the children and 57.9% of the adolescent groups were adherent to GH therapy. Conversely, according to the auto-compliance method almost all the patients were adherent in the children (95.2%) and adolescent (95.5%) groups. Forgetting to take the injection or refill the prescription, being away from home, exhaustion from long-term injection, drug shortage and inaccessibility to the pharmacy were barriers found to be significantly associated with a low adherence in the children group. While in the adolescent group, forgetting to take the injection, painful injection, concern about longterm complications and exhaustion from long-term injection revealed a significant association with low adherence. Persistence with GH therapy was reported in 75.3% and 67% of children and adolescent patients, respectively.

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“…Aydın et al [29] reported that missing renewing the prescription and administering GH were the main causes of the injection omissions.…”

Section: Discussionmentioning

confidence: 99%

Adherence to growth hormone therapy in children and its potential barriers

Mohseni

Heydari

Qorbani

et al. 2017

Journal of Pediatric Endocrinology and Metabolism

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“…In our study, children with short stature had a higher prevalence of Medicaid use, which may be a marker of lower socioeconomic status that could partially explain the higher mortality risk in shorter children despite transplantation. Other factors such as nonadherence to therapy and lower access to care, which are commonly associated with short stature in children with CKD (19)(20)(21), may also be underlying factors that could contribute to the elevated mortality risk in children with short stature.…”

Section: Discussionmentioning

confidence: 99%

Height at First RRT and Mortality in Children

Ku¹,

Fine

Hsu³

et al. 2016

CJASN

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Background and objectives Poor linear growth is common in children with CKD and has been associated with higher mortality. However, recent data in adult dialysis patients have suggested a higher risk of death in persons of tall stature. In this study, we aimed to examine the risk of all-cause and cause-specific mortality in children at both extremes of height at the time of first RRT.Design, setting, participants, & measurements Using the US Renal Data System, we performed a retrospective analysis of 13,218 children aged 2-19 years, who received their first RRT (dialysis or transplant) during 1995-2011. We used adjusted Cox models to examine the association between short (,3rd percentile) and tall (.3rd percentile) stature and risk of death, compared with less extreme heights.Results Over a median follow-up of 7.1 years, there were 1721 deaths. Risk of death was higher in children with short (hazard ratio, 1.49; 95% confidence interval, 1.33 to 1.66) and tall stature (hazard ratio, 1.32; 95% confidence interval, 1.03 to 1.69) in adjusted analysis. In secondary analyses, there was a statistically significant interaction between height and body mass index categories (P=0.04), such that the association of tall stature with higher mortality was limited to children with elevated body mass index (defined as $95th percentile for age and sex). Children with short stature had a higher risk of cardiac-and infection-related death, whereas children with tall stature had a higher risk of cancer-related death.Conclusions Children with short and tall stature are at higher mortality risk, although this association was modified by body mass index at time of first RRT. Studies to further explore the reasons behind the higher risk of mortality in children with extremes of height at the time of first RRT are warranted.

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“…The drop-out rate of four patients out of 52 was very low, in view of the known problems with adherence to GH treatment in routine clinical practice [36]. Out of 52 enrolled patients, follow-up data were unavailable for only two patients.…”

Section: Discussionmentioning

confidence: 95%

Growth response to growth hormone treatment in patients with SHOX deficiency can be predicted by the Cologne prediction model

Hoyer‐Kuhn

Franklin

Jones

et al. 2017

Journal of Pediatric Endocrinology and Metabolism

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Background: Growth hormone (GH) treatment in children with short stature homeobox-containing gene (SHOX) deficiency is recognized to increase height velocity (HV) and adult height. Prediction of growth response continues to be a challenge. A comparatively accurate method is the Cologne prediction model developed in children with GH deficiency. The aim was to investigate whether this model also applies to patients with SHOX deficiency. Methods: Included were 48 patients with SHOX deficiency confirmed by DNA analysis and treated with 0.05 mg/kg/ day of somatropin. Prediction by the Cologne model uses the following variables: relative bone age (BA) retardation, baseline insulin-like growth factor-I (IGF-I), urinary deoxypyridinoline (DPD) cross-links at 4 weeks and HV at 3 months. Results: HV and height standard deviation scores (SDS) increased significantly during the first year of treatment. Predicted and observed HV (cm/year) showed a Pearson correlation coefficient of 0.50 (p < 0.001; root-meansquare error = 1.63) and for first-year change in height SDS a Pearson correlation coefficient of 0.751 (p < 0.001; root-mean-square error = 0.32). Poor response could be adequately predicted using SDS change, with sensitivity and specificity both above 70% for certain thresholds. Conclusions:The results demonstrate that the Cologne model can be used to predict growth response in patients

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Adherence to Growth Hormone Therapy: Results of a Multicenter Study

Cited by 66 publications

References 21 publications

Adherence to growth hormone therapy in children and its potential barriers

Adherence to growth hormone therapy in children and its potential barriers

Height at First RRT and Mortality in Children

Growth response to growth hormone treatment in patients with SHOX deficiency can be predicted by the Cologne prediction model

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