Growth hormone delivery devices: current features and potential for enhanced treatment adherence

Rohrer, Tilman; Horikawa, Reiko; Kappelgaard, Anne-Marie

doi:10.1080/17425247.2017.1243526

Cited by 22 publications

(26 citation statements)

References 76 publications

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“…Overall, our analysis confirms that at 3 years of treatment, the growth of all children is improved by JrGH compared to pre-treatment data; but those patients who are sub-optimally adherent achieve substandard growth outcomes which may not be cost-effective. Addressing factors that influence treatment adherence, especially more effective patient education, needle anxiety recognition and patient product choice may improve cost-effectiveness [26][27][28][29]. Further research in larger cohorts using national databases should now be undertaken to quantify the effect of good adherence on growth parameters with different rGH delivery devices.…”

Section: Discussionmentioning

confidence: 99%

Improved adherence and growth outcomes with jet-delivered growth hormone

Michaelidou

Whitten

Bajaj

et al. 2019

Journal of Pediatric Endocrinology and Metabolism

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Background We previously reported improved persistence and adherence to daily recombinant growth hormone (rGH) in children using jet transjection delivery compared to using needle-based devices. This study examines the relationship between improved adherence and medium-term growth outcomes in children receiving jet-delivered rGH (JrGH) at a single centre. Methods This was a retrospective longitudinal follow-up study of children (<16 years) treated with daily JrGH (somatropin; Ferring Pharmaceuticals) in the form of Zomacton® with the Zomajet® device. Delivery schedules of home distribution services were utilised to calculate adherence, quantified as the proportion of days covered (PDC) index (PDC > 0.8 adherent, PDC ≤ 0.8 less adherent). Demography, patient history, height standard deviation scores (HTSDS) and difference from mid-parental height SDS (MPHSDS − HTSDS) were extracted from hospital records for up to 3 years of treatment. Results Of 75 patients eligible for JrGH, 52 had PDC treatment and height data for at least 1 year and 22 for 3 years. A greater proportion of patients were classified as adherent in both 1- and 3-year treated cohorts (adherent 30 [57.7%] and 14 [63.6%], less adherent 22 [42.3%] and 8 [36.4%]). After 1 year of JrGH treatment, HTSDS was not significantly different in either adherence group. After 3 years, only adherent patients demonstrated sustained year-on-year increments in HTSDS and significant improvement in target HTSDS positions (by 1.32 SDS) compared to baseline (p = 0.0008). MPHSDS – HTSDS showed a similar significant improvement at 3 years in adherent patients only (p = 0.0043). Conclusions Patients adherent to JrGH demonstrate significant growth improvement compared to baseline over 3 years.

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Section: Discussionmentioning

confidence: 99%

Improved adherence and growth outcomes with jet-delivered growth hormone

Michaelidou

Whitten

Bajaj

et al. 2019

Journal of Pediatric Endocrinology and Metabolism

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“…Patient choice will thus most likely feature in this consultation with the clinician when considering device change. Whilst there is little evidence to predict which factors may most likely drive patient device selection ( 12 ), there is growing opinion that injection pen devices that increase the convenience of GH administration are favoured by patients and may subsequently go some way to improve adherence to treatment ( 66 ). In a web-based survey assessing the impact of storage flexibility on the daily life of patients and caregivers administering GH, 86% of respondents who currently used a refrigerator-only product stated that they would “prefer” or “strongly prefer” to use a storage-flexible product.…”

Section: Challenges and Benefits Of Implementing Sdm In Gh Disordersmentioning

confidence: 99%

Shared Decision-Making in Growth Hormone Therapy—Implications for Patient Care

et al. 2018

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Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT. Improved adherence to therapy in this way may consequently positively impact treatment outcomes for patients. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM, and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.

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“…The key factors associated with poor adherence to daily injections are the discomfort associated with injections, dislike of needles, the prolonged treatment period and the complexity of administering the correct dosage. 1 , 6 – 8 Individual and family dynamics and the patient or their family’s understanding of the benefits of treatment and the consequences of poor adherence or non-adherence may also play a role. 1 , 6 Other factors known to impact on adherence to r-hGH therapy include the type of delivery system, cost of treatment, socio-economic status, lack of communication from health care professionals (HCPs), the lack of immediate perceptible benefit causing treatment fatigue, and peer or psychosocial pressure.…”

Section: Introductionmentioning

confidence: 99%

“…These include syringes with hidden needles, disposable pre-filled injector pens, reusable injector pens, an electronic auto-injector, and needle-free injectors. 6 , 9…”

Section: Introductionmentioning

confidence: 99%

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A new pen device for injection of recombinant human growth hormone: a convenience, functionality and usability evaluation study

Sauer¹,

Abbotts²

2017

PPA

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PurposeAdherence to recombinant human growth hormone (r-hGH) is critical to growth and other outcomes in patients with growth disorders, but the requirement for daily injections means that ease of use is an important factor. This study assessed the perceived ease of use and functionality of the prototype of a reusable pen injector (pen device) for r-hGH that incorporates several advanced features.Participants and methodsSemi-structured 60-minute qualitative interviews were conducted in 5 countries with 57 health care professionals (HCPs) and 30 patients with GH deficiency/caregivers administering r-hGH to patients, including children. HCPs had to be responsible for training in the use of r-hGH pen devices and to see ≥4 r-hGH patients/caregivers per month. Patients/caregivers had to have experience with r-hGH administration for at least 6 months.ResultsThirty-seven (65%) of HCPs described the pen device as “simple” or “easy” to use. The aluminum body was generally perceived as attractive, high quality and comfortable to hold and operate. The ease of preparation and use made it suitable for both children and adults. The ability to dial back the r-hGH dose, if entered incorrectly, was mentioned as a major benefit, because other devices need several user steps to reset. Patients/caregivers felt the pen device was easy to use and the injection-feedback features reassured them that the full dose had been given. Overall, 40 (70%) HCPs and 16 (52%) patients/caregivers were likely to recommend or request the pen device. Moreover, patients/caregivers rated the pen device higher than their current reusable pens and almost equal to the leading disposable device for ease of learning, preparation, administration and ease of use.ConclusionThe prototype pen device successfully met its design objectives and was very well accepted by HCPs and patients/caregivers for its ease of use, appearance and functionality.

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Growth hormone delivery devices: current features and potential for enhanced treatment adherence

Cited by 22 publications

References 76 publications

Improved adherence and growth outcomes with jet-delivered growth hormone

Improved adherence and growth outcomes with jet-delivered growth hormone

Shared Decision-Making in Growth Hormone Therapy—Implications for Patient Care

A new pen device for injection of recombinant human growth hormone: a convenience, functionality and usability evaluation study

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