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Akazawa M, Sato T, Ebata N, LoPresti M, Nishi R. Factors Related to Treatment Non-Adherence Among Caregivers of Pediatric and Adolescent Growth Hormone Deficiency Patients in Japan. Patient Prefer Adherence 2024; 18:607-622. [PMID: 38476590 PMCID: PMC10929548 DOI: 10.2147/ppa.s446649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Background About one-third of caregivers of pediatric or adolescent growth hormone deficiency (pGHD) patients in Japan have reported poor treatment adherence. However, few studies have examined factors related to adherence for that group. Objective The aim of this study is to consider factors related to poor adherence to daily treatment among caregivers of pGHD patients in Japan. Methods A cross-sectional survey was conducted among caregivers of pGHD patients in Japan. Caregivers were asked about demographic and treatment characteristics, health literacy, treatment satisfaction, opinions about treatment, and treatment adherence. Health literacy was assessed using the 14-item health literacy scale (HLS-14). Adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Statistical association with adherence was considered using Chi-square and Student's t-testing. An exploratory factor analysis (EFA) and K-means cluster analysis was conducted to consider the influence of treatment satisfaction and opinions concerning treatment on adherence. Results Responses were collected from 112 caregivers. The caregiver's age being 30-39 years old, the primary caregiver being male, the primary caregiver being employed, and low functional health literacy for the caregiver were associated with poor adherence. Patients being pre-elementary school age was also associated with poor adherence. Low satisfaction with drug treatment and/or their device and communication with healthcare professionals (HCPs), and lack of agreement with the importance of treatment management (eg, keeping injection records, getting informed about the disease/therapy, reporting non-adherence, and sticking to an administration schedule), were also associated with poor adherence. Conclusion Strategies to improve treatment adherence among caregivers of pGHD patients in Japan should consider the age, gender, and employment status of the caregiver - as well as their functional literacy. Improvement in satisfaction with the drug or device used, better communication with HCPs, and greater awareness of the importance of treatment management, may also lead to better adherence.
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Affiliation(s)
- Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Takahiro Sato
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Shibuya-ku, Tokyo, Japan
| | - Nozomi Ebata
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Shibuya-ku, Tokyo, Japan
| | - Michael LoPresti
- Value & Access, INTAGE Healthcare Inc., Chiyoda-ku, Tokyo, Japan
| | - Ryosuke Nishi
- Value & Access, INTAGE Healthcare Inc., Chiyoda-ku, Tokyo, Japan
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Takasawa K, Mabe H, Nagamatsu F, Amano N, Miyakawa Y, Sutani A, Kagawa R, Okada S, Tanahashi Y, Suzuki S, Hiroshima S, Nagasaki K, Dateki S, Takishima S, Takahashi I, Kashimada K. Growth Hormone Injection Log Analysis with Electronic Injection Device for Qualifying Adherence to Low-Irritant Formulation and Exploring Influential Factors on Adherence. Patient Prefer Adherence 2023; 17:1885-1894. [PMID: 37545653 PMCID: PMC10404042 DOI: 10.2147/ppa.s417142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Although the treatment success of long-term growth hormone therapy (GHT) is dependent on maintaining patients' adherence to treatment, marked variations in adherence levels among children with GHT (eg, 7-71% nonadherence) have been reported. Barriers to or promoters of GHT adherence have been discussed and investigated, and digital health technologies, such as electronic GH injection devices, may have the potential to assess adherence to GHT more accurately. Thus, we conducted a multicenter, retrospective cohort study using GH injection log analysis of an electronic GH device, GROWJECTOR®L, to qualify adherence and explore the factors influencing adherence. Methods This study enrolled 41 patients (median[range] age, 5.8[3.0 ~ 17.0] years) with short stature from nine Japanese medical institutions. The injection log data (12-48 weeks) were read by smartphones and collected into the data center through a cloud server. Results Although cumulative adherence rates remained higher than 95% throughout the observation period, five (12.2%) patients had low adherence (<85%). Subsequently, subgroup and logistic regression analyses for exploring factors affecting adherence revealed that self-selection of GH device and irregular injection schedule (ie, frequent injections after midnight) significantly affected adherence rate (p=0.034 and 0.048, respectively). In addition, higher rates of irregular injections significantly affected low adherence (median[range], 11.26[0.79 ~ 30.50]% vs 0.26[0.00 ~ 33.33]%, p = 0.029). Discussion Our study indicated that injection log analysis using an electronic GH device could detect irregular injection schedules due to a night owl or disturbance in lifetime rhythm affecting low adherence and had significant potential to encourage collaborative monitoring of adherence with healthcare providers and patients themselves/caregivers, along with growing autonomy and shared decision-making. Our study suggests the significance of narrative and personal approaches to adherence of patients with GHT and the usefulness of digital devices for such an approach and for removing various barriers to patient autonomy, leading to improvement and maintenance of adherence.
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Affiliation(s)
- Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyo Mabe
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Fusa Nagamatsu
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoko Amano
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Yuichi Miyakawa
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Akito Sutani
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Reiko Kagawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Tanahashi
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Shigeru Suzuki
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Shota Hiroshima
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sumito Dateki
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Ikuko Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Interventions Designed to Improve Adherence to Growth Hormone Treatment for Pediatric Patients and Their Families: A Narrative Review. Pharmaceutics 2022; 14:pharmaceutics14112373. [DOI: 10.3390/pharmaceutics14112373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Even though growth hormone (GH) treatment is still the only active treatment option to correct growth failure and increase stature for patients with GH deficiencies, evidence has shown that non-adherence remains high. The aim of this review was to identify and review the existing interventional strategies that have been designed to address and improve adherence to GH treatment for pediatric patients and their families. An extensive search of several electronic databases was undertaken to identify relevant interventional studies, published in English, between 1985 and 2021. Additional search strategies included hand-searching topic review articles to identify eligible studies. Articles were screened against the inclusion eligibility criteria and data on sample characteristics, intervention features, and key findings was extracted. A total of fifteen interventional studies were included in the review. The interventions identified were divided into two broad categories: novel injection devices, and patient choice of device. In conclusions, this review acknowledges that there is a lack of evidence-based, theory-driven intervention strategies, designed with the purpose of optimizing treatment adherence and improve clinical and psychosocial outcomes.
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Lonero A, Giotta M, Guerrini G, Calcaterra V, Galazzi E, Iughetti L, Cassio A, Wasniewska GM, Mameli C, Tornese G, Salerno M, Cherubini V, Caruso Nicoletti M, Street ME, Grandone A, Giacomozzi C, Faienza MF, Guzzetti C, Bellone S, Parpagnoli M, Musolino G, Maggio MC, Bozzola M, Trerotoli P, Delvecchio M. Isolated childhood growth hormone deficiency: a 30-year experience on final height and a new prediction model. J Endocrinol Invest 2022; 45:1709-1717. [PMID: 35567736 DOI: 10.1007/s40618-022-01808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to evaluate the near-final height (nFHt) in a large cohort of pediatricpatients with growth hormone deficiency (GHD) and to elaborate a new predictive method of nFHt. METHODS We recruited GHD patients diagnosed between 1987 and 2014 and followed-up until nFHt. To predict the values of nFHt, each predictor was run in a univariable spline. RESULTS We enrolled 1051 patients. Pre-treatment height was -2.43 SDS, lower than parental height (THt) (-1.09 SDS, p < 0.001). The dose of recombinant human GH (rhGH) was 0.21mg/kg/week at start of treatment. nFHt was -1.08 SDS (height gain 1.27 SDS), higher than pre-treatment height (p < 0.001) and comparable to THt. 1.6% of the patients were shorter than -2 SDS from THt. The rhGH dose at nFHt was 0.19 mg/kg/week, lower than at the start (p < 0.001). The polynomial regression showed that nFHt was affected by gender, THt, age at puberty, height at puberty, age at the end of treatment (F = 325.37, p < 0.0001, R2 87.2%). CONCLUSION This large national study shows that GHD children can reach their THt. The rhGH/kg/day dose significantly decreased from the start to the end of the treatment. Our model suggests the importance of a timely diagnosis, possibly before puberty, the beneficial effect of long-term treatment with rhGH, and the key-role of THt. Our prediction model has a very acceptable error compared to the majority of other published studies.
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Affiliation(s)
- Antonella Lonero
- Giovanni XXIII Children's Hospital, AOU Policlinico di Bari, piazza G.Cesare 11, Bari, Italy
| | - Massimo Giotta
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Giulia Guerrini
- Specialty School of Paediatrics - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Elena Galazzi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Cassio
- Department of Pediatric Endocrinology, Unit of Pediatrics, University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Chiara Mameli
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences, Paediatric Endocrinology Unit, University of Naples 'Federico II', Naples, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Maria Elisabeth Street
- Department of Mother and Child, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Grandone
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Giacomozzi
- Unit of Pediatrics, Department of Maternal and Child Health, Carlo Poma Hospital, ASST-Mantova, Mantua, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Paediatric Unit, University of Bari "A. Moro", Bari, Italy
| | - Chiara Guzzetti
- SSD Endocrinologia Pediatrica e Centro Screening Neonatale, Ospedale Pediatrico Microcitemico "A. Cao", ASSL Cagliari, Novara, Italy
| | - Simonetta Bellone
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Gianluca Musolino
- Ambulatorio di Auxologia ed Endocrinologia pediatrica, S.C. Pediatria, Ospedale Pediatrico "Filippo Del Ponte", ASST Sette Laghi, Varese, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion, Maternal and Infantile Care, Department of Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Maurizio Delvecchio
- Giovanni XXIII Children's Hospital, AOU Policlinico di Bari, piazza G.Cesare 11, Bari, Italy.
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Jouret B, Tauber M. Relationship between adherence to growth hormone therapy and growth. Arch Pediatr 2022; 28:8S9-8S13. [PMID: 37870533 DOI: 10.1016/s0929-693x(22)00037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adherence to growth hormone (GH) therapy in children is variable and remains a problem which can significantly affect the response to GH treatment and future health and also have economic consequences. The response to GH treatment is not predictable at the start of treatment and depends on several factors, the main one being the diagnosis. Knowing the factors associated with poor adherence before treatment initiation can improve the response to treatment. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- B Jouret
- Hôpital des Enfants, Endocrinology Unit, CHU de Toulouse, France.
| | - M Tauber
- Hôpital des Enfants, Endocrinology Unit, CHU de Toulouse, France
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Akazawa M, Shima D, Sato T, Shoji E, LoPresti M, Nishi R. Perception of Adherence to Daily Human Growth Hormone Treatments Among Pediatric and Adolescent Patients in Japan: A Cross-Sectional Survey of Physicians and Caregivers. Patient Prefer Adherence 2022; 16:3081-3094. [PMID: 36387049 PMCID: PMC9661995 DOI: 10.2147/ppa.s380871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Poor adherence to daily human growth hormone (hGH) treatment has been shown to be associated with poor clinical outcomes for growth hormone deficiency (GHD) patients. However, few studies have examined the perception of adherence to hGH treatment among both physicians and caregivers in Japan. OBJECTIVE The aim of this study is to examine the perception of adherence for daily hGH treatment among physicians and caregivers of pediatric and adolescent patients treated with GH in Japan. Moreover, we explore reasons for skipping treatment and the potential impact of a once-weekly treatment on adherence. METHODS A cross-sectional survey was conducted in Japan among physicians that prescribe daily hGH treatment and caregivers that have administered daily hGH treatment to children/adolescents for 3 months or longer. The Morisky Medication Adherence Scale (MMAS-8) was used to gauge perceived adherence for both physician and caregiver groups. Caregivers were also questioned regarding reasons for missing injections. Moreover, both groups were asked about the impact of a once-weekly treatment on adherence. RESULTS Responses were collected from 123 physicians and 112 caregivers. Physicians reported that 18.1% of patients have poor adherence based on the MMAS-8 instrument. In contrast, 32.1% of the caregivers reported poor adherence. "Simply forgetting", "Patient refused/resisted", and being "Busy with school activities, etc" were the most commonly selected reasons by caregivers for missing an injection. Physicians felt that a once-weekly injection could improve adherence for 64.5% of patients with poor adherence. Moreover, 56.9% of the caregivers that reported an experience of missed injections felt that a once-weekly injection would improve their adherence. CONCLUSION Approaches to improve adherence to hGH treatment in Japan are continuously needed. While further research is needed to understand factors most likely to improve adherence, availability of a once-weekly treatment is expected to help improve adherence.
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Affiliation(s)
- Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Daisuke Shima
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Tokyo, Japan
| | - Takahiro Sato
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Tokyo, Japan
- Correspondence: Takahiro Sato, Medical Affairs, Rare Disease, Pfizer Japan Inc, 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan, Tel +81 90-2935-0848, Email
| | - Emi Shoji
- Medical Affairs, Rare Disease, Pfizer Japan Inc, Tokyo, Japan
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Boman N, Fernandez-Luque L, Koledova E, Kause M, Lapatto R. Connected health for growth hormone treatment research and clinical practice: learnings from different sources of real-world evidence (RWE)-large electronically collected datasets, surveillance studies and individual patients' cases. BMC Med Inform Decis Mak 2021; 21:136. [PMID: 33902570 PMCID: PMC8074467 DOI: 10.1186/s12911-021-01491-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A range of factors can reduce the effectiveness of treatment prescribed for the long-term management of chronic health conditions, such as growth disorders. In particular, prescription medications may not achieve the positive outcomes expected because approximately half of patients adhere poorly to the prescribed treatment regimen. METHODS Adherence to treatment has previously been assessed using relatively unreliable subjective methods, such as patient self-reporting during clinical follow-up, or counting prescriptions filled or vials returned by patients. Here, we report on a new approach, the use of electronically recorded objective evidence of date, time, and dose taken which was obtained through a comprehensive eHealth ecosystem, based around the easypod™ electromechanical auto-injection device and web-based connect software. The benefits of this eHealth approach are also illustrated here by two case studies, selected from the Finnish cohort of the easypod™ Connect Observational Study (ECOS), a 5-year, open-label, observational study that enrolled children from 24 countries who were being treated with growth hormone (GH) via the auto-injection device. RESULTS Analyses of data from 9314 records from the easypod™ connect database showed that, at each time point studied, a significantly greater proportion of female patients had high adherence (≥ 85%) than male patients (2849/3867 [74%] vs 3879/5447 [71%]; P < 0.001). Furthermore, more of the younger patients (< 10 years for girls, < 12 years for boys) were in the high adherence range (P < 0.001). However, recursive partitioning of data from ECOS identified subgroups with lower adherence to GH treatment ‒ children who performed the majority of injections themselves at an early age (~ 8 years) and teenagers starting treatment aged ≥ 14 years. CONCLUSIONS The data and case studies presented herein illustrate the importance of adherence to GH therapy and how good growth outcomes can be achieved by following treatment as described. They also show how the device, software, and database ecosystem can complement normal clinical follow-up by providing HCPs with reliable information about patient adherence between visits and also providing researchers with real-world evidence of adherence and growth outcomes across a large population of patients with growth disorders treated with GH via the easypod™ device.
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Affiliation(s)
- Nea Boman
- Paediatric Endocrinology, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbackinkatu 11, PO BOX 281, 00029, Helsinki, Finland.
| | | | - Ekaterina Koledova
- Global Medical Affairs Cardiometabolic and Endocrinology, Merck KGaA, Darmstadt, Germany
| | - Marketta Kause
- Medical Department, Merck Oy Finland (an affiliate of Merck KGaA, Darmstadt, Germany), Espoo, Finland
| | - Risto Lapatto
- Paediatric Endocrinology, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbackinkatu 11, PO BOX 281, 00029, Helsinki, Finland
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Graham S, Neo S, Auyeung V, Weinman J. What Potentially Modifiable Factors are Associated With Treatment Nonadherence in Pediatric Growth Hormone Deficiency? A Quantitative Study. Endocr Pract 2021; 27:146-151. [PMID: 33563559 DOI: 10.4158/ep-2020-0543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/29/2020] [Accepted: 09/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A recent systematic review reported that up to 71% of patients with growth hormone deficiency and their families are nonadherent to treatment as prescribed. Nonadherence to growth hormone treatment presents a substantial and costly problem for the patient, health care provider, and health care system. The current study uniquely investigated the potentially modifiable factors associated with treatment nonadherence in this endocrine disorder. METHODS The cross-sectional study was conducted among 82 parent/caregivers of children with growth hormone deficiency who were receiving growth hormone treatment. Self-report questionnaires investigated parent/caregiver perceptions and experiences of their child's condition and prescribed treatment, in addition to their perceived relationship with their health care professional. The 8-item Morisky medication adherence scale was used for the assessment of treatment adherence. RESULTS Sixty-two percent of parents/caregivers were found to be nonadherent to growth hormone treatment as prescribed. Illness perceptions (consequences, identity, and coherence) and treatment concerns were found to be significantly associated with treatment adherence, as was the quality of the health care professional-parent/caregiver relationship. CONCLUSION The study confirmed the extent of the adherence problem evident among the pediatric growth hormone deficiency population. In addition, it presented an insight into the explanatory factors that underpin nonadherence to growth hormone treatment. Our findings can be used to inform the development of adherence-focused interventions, with the purpose of supporting patients and their families and improving the use of prescribed growth hormone treatment within endocrine clinical practice.
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Affiliation(s)
- Selina Graham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
| | - Samantha Neo
- Health Psychology Section, King's College London, London, United Kingdom
| | - Vivian Auyeung
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
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Blanco-López A, Antillón-Ferreira C, Saavedra-Castillo E, Barrientos-Pérez M, Rivero-Escalante H, Flores-Caloca O, Calzada-León R, Rosas-Guerra CC, Koledova E, Chiquete E, Ayala-Estrada A. Adherence to treatment in children with growth hormone deficiency, small for gestational age and Turner syndrome in Mexico: results of the Easypod™ connect observational study (ECOS). J Endocrinol Invest 2020; 43:1447-1452. [PMID: 32239476 PMCID: PMC7481146 DOI: 10.1007/s40618-020-01218-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Assessing adherence to growth hormone (GH) is challenging. The Easypod™ connect device delivers pre-set doses of recombinant human GH (r-hGH) and stores a digital record of adherence that can be shared with healthcare provider. We assessed adherence to r-hGH delivered with Easypod™ according to the approved pediatric indications for r-hGH: growth hormone deficiency (GHD), born small for gestational age (SGA) who failed to show catch-up growth and Turner syndrome (TS). METHODS ECOS (NCT01555528) was a multicenter (24 countries), 5-year, longitudinal, observational study, which aimed to evaluate country-specific adherence to r-hGH therapy prescribed via the Easypod™ electronic injection device. The primary endpoint was yearly adherence. Secondary endpoints were height velocity, height velocity standard deviation scores (SDS), height, height SDS and IGF-1 concentrations. Clinical and auxological data were obtained from medical records and adherence from Easypod™ logs. RESULTS This study included 147 Easypod™-naïve Mexican children assessed during 3 years (mean age: 9.96 ± 3.41 years, 56.8% boys, mean height SDS at baseline: - 2.17 ± 0.97): 118 with GHD, 24 SGA and 5 with TS. A total of 105 (71.4%) patients were GH naïve. Overall median adherence was > 90% over the first year of treatment and > 80% at 3 years. Adherence was not different by r-hGH indication or between GH-naïve or experienced patients. At 1-year follow-up, mean change in height SDS was 0.57 ± 0.34, whereas mean height velocity SDS was 2.85 ± 2.51. In all, 84.7% patients had normal IGF-1 concentrations at 1-year follow-up. Adherence was associated with change in height SDS (r = 0.239, p = 0.005) and height velocity SDS (r = 0.194, p = 0.027). CONCLUSION Adherence rates with the Easypod™ device are high and maintained over time in GHD, SGA and TS Easypod™-naïve Mexican patients. High adherence is associated with better outcomes. Easypod™ assists physicians in monitoring adherence to r-hGH.
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Affiliation(s)
- A Blanco-López
- Hospital Ángeles Interlomas and Hospital Español, Mexico City, Mexico
| | | | | | | | | | | | - R Calzada-León
- Servicio de Endocrinología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - C C Rosas-Guerra
- Merck Biopharma Distribution S.A. de C.V, Naucalpan de Juárez, Mexico
| | - E Koledova
- Merck Healthcare KGaA, Darmstadt, Germany
| | - E Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Delegacion Tlalpan, C.P. 14080, Ciudad de Mexico, México.
| | - A Ayala-Estrada
- Servicio de Pediatría, Hospital ISSEMyM, Toluca, Estado de México, México.
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Demiral M, Unal E, Baysal B, Baran RT, Demirbilek H, Özbek MN. Evaluation of the Final Adult Height and Its Determinants in Patients with Growth Hormone Deficiency: A Single-centre Experience from the South-Eastern Region of Turkey. J Clin Res Pediatr Endocrinol 2020; 12:295-302. [PMID: 32157854 PMCID: PMC7499137 DOI: 10.4274/jcrpe.galenos.2020.2019.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim was to determine the final adult height (FAH) achieved by recombinant human growth hormone (rhGH) treatment, the factors affecting FAH and the success of attaining the genetic potential. METHODS Data of 133 patients treated with rhGH therapy were reviewed retrospectively. Patients were grouped according to diagnosis, either isolated GH deficiency (IGHD) or multiple pituitary hormone deficiency (MPHD), and by sex, and pubertal status at the beginning of treatment. RESULTS The mean age of initiation of treatment was 12.3±2.18 years, and the mean duration of rhGH treatment was 3.65±1.5 years. The mean height standard deviation score (SDS) at diagnosis was -3.11±0.75 SD. All patients received a standardized GH dose of 0.033 mg/kg/day. Mean FAH-SDS was -1.8±0.77 and delta height-SDS (the change in height SDS between the beginning and end of treatment) was 1.28±0.94 SD. FAH-SDS was -1.79±0.86 SD in males; -1.82±0.64 in females (p=0.857); -1.94±0.71 at the beginning of treatment in pubertal patients and -1.68±0.81 in prepubertal patients (p=0.056); -1.84±0.89 in patients with IGHD and -0.47±0.2 in patients with MPHD (p˃0.05). In multiple regression analysis, First year delta height-SDS was the most predictive factor for both FAH-SDS and delta height-SDS. CONCLUSION The majority of our patients achieved a final height compatible with their genetic potential as well as population standards when treated with rhGH even having started at a relatively late age. First year delta height-SDS was a predictive factor for FAH.
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Affiliation(s)
- Meliha Demiral
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey,* Address for Correspondence: Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey Phone: +90 535 588 56 49 E-mail:
| | - Edip Unal
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital, Clinic of Paediatric Endocrinology, Antalya, Turkey
| | - Hüseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatric Endocrinology, Diyarbakır, Turkey
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11
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Charmandari E, Vlachopapadopoulou E, Kyritsi EM, Sakellariou D, Koledova E, Nespithal K, Michalacos S. Adherence and long-term outcomes of therapy in paediatric patients in Greece using the easypod™ electromechanical device for growth hormone treatment: The phase IV multicentre easypod™ connect observational study (ECOS). Growth Horm IGF Res 2020; 53-54:101336. [PMID: 32739654 DOI: 10.1016/j.ghir.2020.101336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The easypod™ injection device allows automatic recording and transmission of adherence data from patients receiving recombinant human growth hormone (rhGH [Saizen®]) to treat growth disorders. This analysis aimed to evaluate the adherence of Saizen® administered via easypod™ in a cohort of Greek patients from the easypod™ connect observational study (ECOS). METHODS The phase IV, open-label, multicentre, observational, and longitudinal ECOS study (EMR200104-520, NCT01363674) enrolled patients treated for a minimum of 6 months and up to 3 years. The primary endpoint was to assess the mean rate of adherence to treatment at different time points, where good adherence was defined as ≥85%. Change in height, height standard deviation score (SDS), height velocity and height velocity SDS were evaluated after 1 year of treatment as secondary endpoints, together with the impact of adherence on growth outcomes using the Spearman's product moment. RESULTS Of the 180 patients enrolled, 86 were included in the analysis. The mean adherence to Saizen®, as recorded via easypod™, was high at each individual time point, and was maintained at 95.5% after 1 year of treatment. Clinically meaningful positive changes were also noted for all of the secondary endpoints (median increase in height = 7.25 cm, height SDS = 0.32, median height velocity = 7.62 cm/year and height velocity SDS = 1.65). However, no significant correlation was noted between adherence and growth outcomes. CONCLUSIONS rhGH replacement therapy using Saizen® with easypod™ led to full compliance to the treatment in a representative Greek population from ECOS, and provided additional insights on how the easypod™ device can assist physicians in monitoring adherence and help to optimise linear growth in paediatric patients with growth disorders.
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Affiliation(s)
- E Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece.
| | - E Vlachopapadopoulou
- Department of Endocrinology - Growth and Development, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - E M Kyritsi
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | | | | | | | - S Michalacos
- Department of Endocrinology - Growth and Development, P. & A. Kyriakou Children's Hospital, Athens, Greece
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12
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Koledova E, Tornincasa V, van Dommelen P. Analysis of real-world data on growth hormone therapy adherence using a connected injection device. BMC Med Inform Decis Mak 2020; 20:176. [PMID: 32727461 PMCID: PMC7389874 DOI: 10.1186/s12911-020-01183-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Poor adherence to long-term recombinant human growth hormone (r-hGH) treatment can lead to suboptimal clinical outcomes; consequently, supporting and monitoring adherence is a crucial part of patient management. We assessed adherence to r-hGH treatment in children with growth disorders over 48 months using a connected monitoring device (easypod™), which automatically transmits adherence data via an online portal (easypod™ connect); both sit within an adherence decision support system (ADSS). We also investigated the effect of age and sex on adherence. Methods Data from children transmitting over 10 injections between January 2007 and February 2019 were analyzed. Adherence (mg injected/mg prescribed) was categorized as high (≥85%), intermediate (> 56–84%) or low (≤56%) and assessed at seven time points from the start of treatment up to 48 months. Adherence was investigated over time and stratified by puberty status and sex. Mean transmission rate in each adherence category (total number of transmissions/total number of children) at each time point was calculated as a proxy measure of engagement in disease and treatment management. Descriptive analyses were performed. Results Longitudinal records were available for 13,553 children. Overall, 71% (n = 9578) had high adherence, 22% (n = 2989) intermediate and 7% (n = 986) low. The proportion of children with high adherence decreased over time from 87% (n = 12,964) to 65% (n = 957) and was higher in pre-pubertal than pubertal children (girls: 80% [n = 1270] vs 70% [n = 4496]; boys 79% [n = 2573] vs 65% [n = 5214]). Children with high adherence had a higher mean number of transmissions (12.5 [SD 24.9]) than children with intermediate (7.2 [SD 15.3]) or low (3.5 [SD 5.7]) adherence. Conclusions High adherence was seen in patients administering r-hGH using the connected device. Children with high adherence were most likely to regularly transmit data. Pubertal children showed lower adherence. We show the potential to develop an ADSS to analyze trends in real-world adherence data. This may prove useful to direct interventions to improve adherence while the ability to readily share data with healthcare professionals may itself improve adherence.
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Affiliation(s)
- Ekaterina Koledova
- Endocrinology Global Medical, Safety and CMO, Merck KGaA, 64293, Darmstadt, Germany.
| | - Vincenzo Tornincasa
- Merck Connected Health and Devices, Ares Trading S.A., an affiliate of Merck KGaA, 1262, Eysins, Switzerland
| | - Paula van Dommelen
- The Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
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Graham S, Auyeung V, Weinman J. Exploring Potentially Modifiable Factors That Influence Treatment Non-Adherence Amongst Pediatric Growth Hormone Deficiency: A Qualitative Study. Patient Prefer Adherence 2020; 14:1889-1899. [PMID: 33116433 PMCID: PMC7569171 DOI: 10.2147/ppa.s268972] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A recent systematic review found that up to 71% of children with growth hormone deficiency and their families are non-adherent to treatment as prescribed. A key way to better understanding the complex issue of pediatric non-adherence is to explore the perceptions and experiences of the parent/caregiver. Our study is the first to look specifically at the potentially modifiable factors that influence non-adherence to rhGH treatment amongst parents/caregivers of children with this endocrine disorder. METHODS Fourteen semi-structured telephone interviews were conducted to explore parents/caregivers' perceptions and experiences of their child's condition and prescribed treatment, in addition to their perceived relationship with their healthcare professional. The findings were thematically analyzed and narratively synthesized, in line with the qualitative approach of Braun and Clarke (2006). RESULTS Potentially modifiable factors that influence non-adherence to growth hormone treatment were grouped under four themes: 1. Device Burdens, 2. Treatment Considerations, 3. Logistical Interferences and 4. Interpersonal Influences. CONCLUSION Our exploratory study presents the wide range of potentially modifiable factors that influence the way in which growth hormone treatment is used. These findings can, in turn, be used to inform and promote the development of targeted, adherence-focused interventions, to support growth hormone deficient children and their families and optimize the use of prescribed growth hormone treatment within endocrine clinical practice.
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Affiliation(s)
- Selina Graham
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Correspondence: Selina Graham School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, London, UK Email
| | - Vivian Auyeung
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - John Weinman
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
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Centonze C, Guzzetti C, Orlando G, Loche S. Adherence to growth hormone (GH) therapy in naïve to treatment GH-deficient children: data of the Italian Cohort from the Easypod Connect Observational Study (ECOS). J Endocrinol Invest 2019; 42:1241-1244. [PMID: 30968283 PMCID: PMC6751271 DOI: 10.1007/s40618-019-01046-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the use of non-objective measurement, adherence to growth hormone (GH) therapy has been reported suboptimal in a large proportion of patients, and poor adherence has been shown to affect short-term growth response in patients receiving GH treatment. OBJECTIVE The Easypod™ electronic device allows objective measurement of adherence. In this study, we report 3-year prospective adherence data of the Italian cohort of naïve GH deficient (GHD) children extrapolated from the Easypod Connect Observational Study (ECOS) database. PATIENTS AND METHODS Seventy-three GHD children naïve to GH treatment were included in the analysis. 22 Italian centers participated in the study. RESULTS Mean adherence rate was consistently above 85% across the 3-year observation period. Particularly, mean adherence was 88.5%, 86.6%, and 85.7% after 1, 2 and 3 years, respectively. Mean (± SD) height-SDS increase after the first year was 0.41 (± 0.38). CONCLUSIONS The majority of naïve GHD children starting GH treatment with Easypod maintained an adherence rate > 85% up to 3 years. Easypod is a useful tool to follow-up patients' adherence allowing timely intervention to improve optimal treatment for these patients.
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Affiliation(s)
- C Centonze
- Medical Affairs Department, Merck Serono S.p.A., Rome, Italy
| | - C Guzzetti
- SSD di Endocrinologia Pediatrica e, Centro Screening Neonatale, Ospedale Pediatrico Miccrocitemico "A. Cao", AO Brotzu, Via Jenner, 09121, Cagliari, Italy
| | - G Orlando
- Medical Affairs Department, Merck Serono S.p.A., Rome, Italy
| | - S Loche
- SSD di Endocrinologia Pediatrica e, Centro Screening Neonatale, Ospedale Pediatrico Miccrocitemico "A. Cao", AO Brotzu, Via Jenner, 09121, Cagliari, Italy.
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Rodríguez Arnao MD, Rodríguez Sánchez A, Díez López I, Ramírez Fernández J, Bermúdez de la Vega JA, Yeste Fernández D, Chueca Guindulain M, Corripio Collado R, Pérez Sánchez J, Fernández González A. Adherence and long-term outcomes of growth hormone therapy with easypod™ in pediatric subjects: Spanish ECOS study. Endocr Connect 2019; 8:1240-1249. [PMID: 31484160 PMCID: PMC6733364 DOI: 10.1530/ec-19-0325] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Non-adherence to r-hGH treatments occurs in a variable percentage of subjects. One problem found when evaluating adherence is the great variability in methods of detection and definitions utilized in studies. This study assessed the level of adherence in subjects receiving r-hGH with the easypod™ electronic device. METHODS National, multicenter, prospective and observational study involving 238 subjects (144 with GH deficiency (GHD), and 86 with small for gestational age (SGA), 8 with Turner Syndrome), who received r-hGH with easypod™ for at least 3 months before inclusion. The follow-up period was 4 years. RESULTS Overall adherence was 94.5%; 97.5% after 6 months, 95.3% after 1 year, 93.7% after 2, 94.4% after 3 and 95.5% after 4 years of treatment. No differences in adherence were observed between prepubertal and pubertal groups and GHD and SGA groups. Change in height after 1 and 2 years, change in height SDS after 1 and 2 years, HV after 1 year, HV SDS after at 1 and 4 years, change in BMI after 1 year and change in BMI SDS at 1 and 2 years showed significant correlation with adherence. No significant differences in adherence according to IGF-I levels were found in follow-up visits or between groups. CONCLUSIONS The easypod™ electronic device, apart from being a precise and objective measure of adherence to r-hGH treatment, allows high compliance rates to be achieved over long periods of time. Adherence significantly impacts growth outcomes associated with r-hGH treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - ECOS Spain Study Collaborative Investigator Group
- Pediatric Endocrinology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital Universitario Araba, Araba/Alava, Spain
- Hospital Universitario Príncipe de Asturias, Oviedo, Spain
- Centro Nuevas Tecnologias, Sevilla, Spain
- Hospital Vall d’Hebrón, Barcelona, Spain
- Complejo Hospitalario de Navarra, Pamplona, Spain
- Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
- Merck S.L.U., Madrid, Spain
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Amereller F, Schilbach K, Schopohl J, Störmann S. Adherence, Attitudes and Beliefs of Growth Hormone Deficient Patients - A Questionnaire-based Cohort Study. Exp Clin Endocrinol Diabetes 2019; 129:112-117. [PMID: 31266067 DOI: 10.1055/a-0956-1919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION GHD is a chronic and systemic disease requiring daily replacement of growth hormone (GHRT). Adherence and attitudes of adult GHD patients are not well known. We sought to assess patients' knowledge of growth hormone deficiency (GHD) in association with treatment adherence and attitudes regarding available and upcoming treatment options. METHODS We performed a cross-sectional survey with a custom-made questionnaire at a single centre assessing data on demographics, knowledge of GHD, adherence and attitudes towards GHRT. RESULTS Of 106 eligible patients actively followed for GHD 70 returned the completed survey (return-rate 66%, 34 m/36 f; age 56±14 years). 46 patients were actively treated, but almost one third (n=24) refused GHRT. 12 patients had participated in clinical trials with LAGH (long-acting growth hormone). Overall, patients with GHRT showed good adherence. Patients refusing GHRT mostly feared side effects and/or had a lack of information/perceived effect. Disease knowledge and level of education were higher in treated than untreated patients (p=0.023/0.017). Only 36% of respondents would initiate treatment with LAGH. Patients with prior LAGH experience and patients with childhood-onset GHD were more likely to adopt LAGH (p=0.048/0.031). DISCUSSION Most often, misinformation causes patients to refuse GHRT. Possibly the understanding of their condition and consequences of non-treatment is limited. To improve adherence more focused educational and behavioural strategies may be needed. Willingness to begin a therapy with LAGH was lower than expected (36%). The reasons for reluctance against LAGH need to be elucidated.
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Affiliation(s)
- Felix Amereller
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
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Graham S, Weinman J, Auyeung V. Identifying Potentially Modifiable Factors Associated with Treatment Non-Adherence in Paediatric Growth Hormone Deficiency: A Systematic Review. Horm Res Paediatr 2019; 90:221-227. [PMID: 30522126 DOI: 10.1159/000493211] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the developments of recombinant growth hormone (rhGH) treatment and the benefits in long-term clinical health outcomes, evidence has shown that many children with growth hormone deficiency (GHD) still fail to achieve their target adult height. Suboptimal outcomes have been largely attributed to treatment non-adherence. METHODS A search of 11 electronic databases was undertaken to identify relevant articles, published in English, between 1985 and 2018. Additional search strategies included hand-searching topic review articles to identify eligible studies. Articles were screened against the inclusion eligibility criteria and data on sample characteristics, study design, outcomes, and key findings was extracted. The results were narratively synthesised and categorised using the COM-B theoretical framework. RESULTS Twenty-one full-text articles were assessed for eligibility, of which 6 articles met the inclusion criteria. The prevalence of non-adherence in the included studies varied from 7 to 71%. Potentially modifiable factors associated with rhGH non-adherence were categorised within the COM-B framework; key factors included: a lack of knowledge and understanding of the condition and treatment, discomfort and pain associated with injections, and the quality of the healthcare professional-patient relationship. CONCLUSION This review highlights the scope of the adherence problem evident amongst the paediatric GHD population and in addition presents the wide range of potentially modifiable factors that explain this health-related behaviour.
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Affiliation(s)
- Selina Graham
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom,
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
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Farfel A, Shalitin S, Morag N, Meyerovitch J. Long-term adherence to growth hormone therapy in a large health maintenance organization cohort. Growth Horm IGF Res 2019; 44:1-5. [PMID: 30414995 DOI: 10.1016/j.ghir.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/10/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Adherence to treatment regimen is a key factor in the success of Growth Hormone (GH) therapy. Our objective was to assess the long time adherence to treatment in a large cohort of patients. DESIGN It is a retrospective study. The data was collected from a single central computerized data center well maintained and checked for quality. All patient aged 1-16 years, treated with GH during 2006-2015 for >2 years, who were insured by "Clalit" Health Maintenance Organization. Adherence was measured by the number of months of pharmacy purchased GH annually: good (11-12), moderate (7-10), and poor (<7) months per year. RESULTS 2263 patients (59% males) were treated for >2 years. Mean age at treatment initiation was 8.3 ± 3.6 years, 74% were secular Jews, 6.8% ultra-religious Jews and 18.9% of Arab origin. Only 30% of patients had good adherence to GH therapy. Patients who started treatment before age 8 years had poorest adherence rate. No association was found between adherence to GH therapy and gender or socioeconomic status. In a multivariate analysis (gender, age groups, ethnicity and clinic SES) we found the ultra-religious population had higher risk for non adherence (OR 2.16, CI 95% 1.46-3.19). The poorest adherence by age was in the youngest patients. In patients treated for >5 years (n = 668), adherence rate declined slightly over the years. CONCLUSIONS Long term adherence to GH therapy is suboptimal. Measures for improving adherence especially among younger and ultra- religious patients are needed.
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Affiliation(s)
- Alon Farfel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Department of Pediatrics, Assuta Hospital, Ashdod, Israel
| | - Shlomit Shalitin
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nira Morag
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Meyerovitch
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Chief Pediatrician, Community Division, Clalit Health Services, Tel Aviv, Israel.
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Mancini A, Vergani E, Bruno C, Palladino A, Brunetti A. Relevance of Adherence Monitoring in Adult Patients With Growth Hormone Deficiency Under Replacement Therapy: Preliminary Monocentric Data With Easypod TM Connect. Front Endocrinol (Lausanne) 2019; 10:416. [PMID: 31316468 PMCID: PMC6610218 DOI: 10.3389/fendo.2019.00416] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/10/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose: Non-compliance to recombinant human growth hormone (r-hGH) therapy in adult growth hormone deficiency (aGHD) is a major concern for endocrinologist, as it affects significantly efficacy outcomes. This 12-month observational study was aimed to assess adherence in GHD patients treated with r-hGH administered via EasypodTM, an electronic, fully automated injection device designed to track the time, date and dose administered. Methods: 65 patients receiving r-hGH therapy were included in the study and 32 completed the study. The primary endpoint, adherence to treatment, was calculated as the proportion of injections correctly administered during the observational period out of the expected total number of injections. Adherence, tracked by the EasypodTM, was evaluated at months 6 (V1) and 12 (V2) after baseline (V0). As secondary end-point, serum IGF-1 levels were also determined. Results: The EasypodTM data showed a median adherence of 80% throughout the period V0-V2. Females are more compliant than males. Adherence levels are correlated to IGF-1 ones. Conclusions: Adherence is connected with therapy efficacy in aGHD. The injection-recording system and other characteristics of EasypodTM could enhance the ability of physicians to monitor adherence to r-hGH treatment, identifying non-compliant patients, thus enabling physicians to modify their management to maximize the benefits of the treatment.
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Cardinale GM, Pesce S, Ingletto D, Mariano M, Catucci A, Corciulo N, Fidotti E. Monitoring of treatment adherence with easypod™ in six Italian centers: a real-world experience. MINERVA ENDOCRINOL 2018; 44:246-251. [PMID: 30482007 DOI: 10.23736/s0391-1977.18.02843-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A poor adherence to r-hGH therapy is associated to a low growth rate in patients with growth deficiency. For this reason, the choice of an objective method, such as an electronic device, for monitoring treatment adherence is very important. This retrospective study evaluated the r-hGH treatment adherence of patients with growth deficiency, monitored through the easypod™ device. METHODS Data from 90 patients (52 males and 38 females; mean age at the end of the study: 11.9 years ±3.40) enrolled in six Italian centers, was collected from the beginning of the r-hGH therapy until the end of the study through the easypod™ device. The primary endpoint, i.e. treatment adherence, was the ratio between actual days of treatment and planned days of treatment. Secondary endpoints were: relationship between heights measured at the beginning and at the end of the study, the change of the height SDS and the growth rate. RESULTS Data from easypod™ showed that the mean adherence was 70±13%. The mean age-adjusted growth of the patients was 28.68±13.8 cm during the treatment period of 977 days, and the 6-month growth rate for the planned period was 3.78±8.1 cm. A positive correlation between the adherence rate and the change of the height SDS value was observed (P<0.0006). CONCLUSIONS The easypod™ device seems to be a valid tool for quickly identifying non-adherence habits, allowing physicians to implement actions focused on reinforcing the importance of treatment both for patients and caregivers.
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Affiliation(s)
| | - Sabino Pesce
- Unit of Endocrinology and Metabolic Diseases, Giovanni XXIII Children's Hospital, Polyclinic of Bari, Bari, Italy
| | - Dario Ingletto
- Unit of Pediatrics, Cardinale Giovanni Panico Hospital, Tricase, Lecce, Italy
| | - Matteo Mariano
- Department of Pediatrics and Neonatology, ASL Foggia, Teresa Masselli Mascia Hospital, San Severo, Foggia, Italy
| | - Alessandra Catucci
- Department of Neonatology and Neonatal Intensive Care, Ospedali Riuniti, Foggia, Italy
| | - Nicola Corciulo
- Unit of Auxology and Pediatric Endocrinology, Sacred Heart of Jesus Hospital, Gallipoli, Lecce, Italy
| | - Enrico Fidotti
- Unit of Endocrinology, San Camillo-Forlanini Hospital, Rome, Italy
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Koledova E, Stoyanov G, Ovbude L, Davies PSW. Adherence and long-term growth outcomes: results from the easypod ™ connect observational study (ECOS) in paediatric patients with growth disorders. Endocr Connect 2018; 7:914-923. [PMID: 29976785 PMCID: PMC6107763 DOI: 10.1530/ec-18-0172] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/05/2018] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The easypod connect observational study (ECOS) assessed treatment adherence among paediatric patients receiving growth hormone (GH) via the easypod electronic injection device. DESIGN ECOS was an open-label, observational, longitudinal study conducted in 24 countries between 2010 and 2016, enrolling children treated with GH. METHODS The primary endpoint was the rate of treatment adherence during 5 years of follow-up. Impact of adherence on growth outcomes was assessed using Spearman's product-moment correlations. RESULTS AND CONCLUSIONS Overall, 1190 patients had easypod data available for ≥3 months; most patients had GH deficiency (75%); 606 of these patients were GH naïve at baseline. Over the first year of monitoring, the median rate of adherence was 93.7% among patients overall and >93.0% in GH-naïve patients, irrespective of the treatment indication. Clinically meaningful improvements in growth rates were observed after 1 year of treatment across all GH indications. Adherence decreased with increasing treatment duration, but the overall median adherence rate remained high after 3 years of follow-up: 87.2% (n = 409), 75.5% after 4 years (n = 143) and 70.2% after 5 years (n = 43). Statistically significant correlations between adherence and 1-year change in height standard deviation score (P < 0.001 for patients overall) and height velocity (P < 0.001) were observed. CONCLUSIONS ECOS produced accurate, real-time adherence data in a large population of GH-treated children over 5 years of follow-up. Using the easypod connect system, physicians can potentially identify patients with inadequate adherence and poor response to treatment, enabling them to take appropriate action to help them maximise the benefits of GH treatment.
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Affiliation(s)
- Ekaterina Koledova
- Biopharma Global Medical AffairsGeneral Medicine and Endocrinology, Merck KGaA, Darmstadt, Germany
| | - George Stoyanov
- Biopharma Global Medical AffairsGeneral Medicine and Endocrinology, Merck KGaA, Darmstadt, Germany
| | - Leroy Ovbude
- Business & Decision Life SciencesBrussels, Woluwe-Saint-Lambert, Belgium
| | - Peter S W Davies
- Children’s Nutrition Research CentreFaculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Arrabal Vela MA, García Gijón CP, Pascual Martin M, Benet Giménez I, Áreas Del Águila V, Muñoz-Rodríguez JR, Palomo Atance E. Adherence to somatotropin treatment administered with an electronic device. ACTA ACUST UNITED AC 2018; 65:314-318. [PMID: 29680781 DOI: 10.1016/j.endinu.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Adherence to somatotropin treatment is associated with increased growth velocity and improved adult height. The purpose of this study is to determine the adherence of patients undergoing treatment with an electronic device and its relationship with different variables (age, gender, duration of treatment, diagnosis, height, and growth rate). MATERIAL AND METHODS Descriptive, longitudinal and retrospective study of children less than 14 years of age undergoing treatment with somatotropin administered with the Easypod® electronic device in the Paediatric Endocrinology Outpatient Clinic of the General University Hospital of Ciudad Real, Spain. Adherence was monitored for 12 months and was defined according to the equation: (days administered at the prescribed dose / prescribed days)×100. The data analysis was performed using SPSS software. RESULTS Data were collected from 30 patients, with a predominance of males (57%), a mean age of 6.09 years, with 51% of children less than 5 years old. The most common reasons for the treatment were: small for gestational age (55%) and growth hormone deficiency (38%). The mean duration of treatment was 4.3 years (3.6-5). A mean adherence of 92.3% (87.7-96.9) was observed, and there was a significant correlation with age (Pearson R = -0.384, P=.03), and duration of treatment (Pearson R = -0.537; P=.003). CONCLUSIONS The adherence in our patients with electronic device is high (92.3%), and is inversely associated with age and duration. The use of electronic devices allows monitoring of therapeutic compliance, which affects the optimisation of treatment.
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Affiliation(s)
| | - Carlota Prado García Gijón
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario Ciudad Real, Ciudad Real, España
| | - María Pascual Martin
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario Ciudad Real, Ciudad Real, España
| | - Isabel Benet Giménez
- Servicio Farmacia Hospitalaria, Hospital General Universitario Ciudad Real, Ciudad Real, España
| | - Vera Áreas Del Águila
- Servicio Farmacia Hospitalaria, Hospital General Universitario Ciudad Real, Ciudad Real, España
| | | | - Enrique Palomo Atance
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario Ciudad Real, Ciudad Real, España
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Sultan S, El-Hourani M, Rondeau É, Garnier N. Categorizing factors of adherence to parenteral treatment in growth hormone deficiencies and hemophilia: What should be the targets for future research? Patient Prefer Adherence 2018; 12:2039-2063. [PMID: 30349200 PMCID: PMC6188171 DOI: 10.2147/ppa.s177624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Adherence to treatment regimens in growth hormone dysregulations and hemophilia is related to better outcome and fewer complications over time. Subcutaneous growth hormone injection and intravenous blood factor replacement therapies are parenteral treatments with a comparable regimen calling for similar behavioral processes. Although we have lists of possible factors influencing adherence in these conditions, the evidence is scattered. The objective of this study was to systematically review empirical studies linking factors of adherence with measures of adherence. To categorize the factors, we used a taxonomy from the diabetes literature. We used four major electronic databases to identify articles. We synthesized 27 articles dated 2011-2017 corresponding to inclusion criteria. Results showed a consistent proportion of 20%-25% participants with adherent issues. Strong arguments pointed to the transition to self-care in pediatrics as a vulnerability period (7/27 reports). We found the domains of individual factors (<30% reports), relational factors (<13%), health care (<30%), to be understudied in comparison with that of demographic or clinical context (>74%), and practical issues (>37%). The results suggest that future research should focus on modifiable factors of adherence, with appropriate measurement and intervention strategies. One central methodological limitation of reviewed reports was the lack of longitudinal designs, and the quasi absence of behavioral trial targeting modifiable factors of adherence. A new research agenda should be set in these rare diseases as higher adherence should translate into improved outcome and better quality of life for patients and their families.
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Affiliation(s)
- Serge Sultan
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, Québec, Canada,
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada,
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada,
| | - Mira El-Hourani
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada,
| | - Émélie Rondeau
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, Québec, Canada,
| | - Nicolas Garnier
- Pfizer Canada Inc, Rare Disease Unit, Medical Affairs, Kirkland, Québec, Canada
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24
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Isojima T, Hasegawa T, Yokoya S, Tanaka T. The response to growth hormone treatment in prepubertal children with growth hormone deficiency in Japan: Comparing three consecutive years of treatment data of The Foundation for Growth Science in Japan between the 1990s and 2000s. Endocr J 2017; 64:851-858. [PMID: 28679975 DOI: 10.1507/endocrj.ej17-0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Growth hormone (GH) treatment for children with GH deficiency (GHD) is effective in improving adult height. To achieve favorable effects, GH treatment before puberty is very important, because prepubertal height gain is highly correlated with total height gain. However, no report has studied the effects by analyzing a nationwide data from recent GHD patients in Japan. We investigated the response to GH treatment using data compiled in the Foundation for Growth Science in Japan, and compared the effects between the 1990s and 2000s using analysis of covariance. We analyzed 534 prepubertal GHD subjects treated in the 2000s with three consecutive years of data from the start and investigated predictive factors for the effects. The cumulative height standard deviation score (SDS) change over three years of GH treatment was 0.91 ± 0.57 and 1.20 ± 0.62 in the 1990s and 2000s, respectively. Subjects in the 2000s were divided into three groups by severity, and the cumulative height SDS was 1.60 ± 0.93, 1.20 ± 0.54, and 1.00 ± 0.40 indicating severe, moderate, and mild GHD, respectively. Age and height SDS at the start and severity were identified as independent predictive factors. We also found a significant difference in the effects between the two cohorts after adjusting for the different factors (regression coefficient: -0.069, 95% confidence interval: -0.11 to -0.030, p = 0.0006), which might be due to the GH dose effect. We conclude that the effects of GH treatment in the 2000s had improved compared with those in the 1990s.
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Affiliation(s)
- Tsuyoshi Isojima
- Growth Hormone (GH) and its related Factors Study Committee and GH Treatment Study Committee, The Foundation for Growth Science in Japan, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Growth Hormone (GH) and its related Factors Study Committee and GH Treatment Study Committee, The Foundation for Growth Science in Japan, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Susumu Yokoya
- Growth Hormone (GH) and its related Factors Study Committee and GH Treatment Study Committee, The Foundation for Growth Science in Japan, Tokyo, Japan
- Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiaki Tanaka
- Growth Hormone (GH) and its related Factors Study Committee and GH Treatment Study Committee, The Foundation for Growth Science in Japan, Tokyo, Japan
- Tanaka Growth Clinic, Tokyo, Japan
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25
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Léger J, Mohamed D, Dos Santos S, Ben Azoun M, Zénaty D, Simon D, Paulsen A, Martinerie L, Chevenne D, Alberti C, Carel JC, Guilmin-Crepon S. Impact of the underlying etiology of growth hormone deficiency on serum IGF-I SDS levels during GH treatment in children. Eur J Endocrinol 2017; 177:267-276. [PMID: 28760908 DOI: 10.1530/eje-17-0215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/14/2017] [Accepted: 06/29/2017] [Indexed: 11/08/2022]
Abstract
CONTEXT Regular monitoring of serum IGF-I levels during growth hormone (GH) therapy has been recommended, for assessing treatment compliance and safety. OBJECTIVE To investigate serum IGF-I SDS levels during GH treatment in children with GH deficiency, and to identify potential determinants of these levels. DESIGN, PATIENTS AND METHODS This observational cohort study included all patients (n = 308) with childhood-onset non-acquired or acquired GH deficiency (GHD) included in the database of a single academic pediatric care center over a period of 10 years for whom at least one serum IGF-I SDS determination during GH treatment was available. These determinations had to have been carried out centrally, with the same immunoradiometric assay. Serum IGF-I SDS levels were determined as a function of sex, age and pubertal stage, according to our published normative data. RESULTS Over a median of 4.0 (2-5.8) years of GH treatment per patient, 995 serum IGF-I SDS determinations were recorded. In addition to BMI SDS, height SDS and GH dose (P < 0.01), etiological group (P < 0.01) had a significant effect on serum IGF-I SDS levels, with patients suffering from acquired GHD having higher serum IGF-I SDS levels than those with non-acquired GHD, whereas sex, age, pubertal stage, treatment duration, hormonal status (isolated GHD (IGHD) vs multiple pituitary hormone deficiency (MPHD)) and initial severity of GHD, had no effect. CONCLUSIONS These original findings have important clinical implications for long-term management and highlight the need for careful and appropriate monitoring of serum IGF-I SDS and GH dose, particularly in patients with acquired GHD, to prevent the unnecessary impact of potential comorbid conditions.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1141, DHU Protect, Paris, France
| | - Damir Mohamed
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Unit of Clinical Epidemiology, Paris, France
- Inserm, CIC-EC 1426, Paris, France
| | - Sophie Dos Santos
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
| | - Myriam Ben Azoun
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
| | - Delphine Zénaty
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
| | - Dominique Simon
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
| | - Anne Paulsen
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
| | - Laetitia Martinerie
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1141, DHU Protect, Paris, France
| | - Didier Chevenne
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service de Biochimie-Hormonologie, Paris, France
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Unit of Clinical Epidemiology, Paris, France
- Inserm, CIC-EC 1426, Paris, France
| | - Jean-Claude Carel
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1141, DHU Protect, Paris, France
| | - Sophie Guilmin-Crepon
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du développement, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Unit of Clinical Epidemiology, Paris, France
- Inserm, CIC-EC 1426, Paris, France
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26
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Gau M, Takasawa K. Initial patient choice of a growth hormone device improves child and adolescent adherence to and therapeutic effects of growth hormone replacement therapy. J Pediatr Endocrinol Metab 2017; 30:989-993. [PMID: 28771439 DOI: 10.1515/jpem-2017-0146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is thought that growth hormone (GH) therapy success depends on the patient's adherence to their treatment regimen, but an optimal approach to improve adherence has not yet been established. METHODS To evaluate the effect of patient choice of a GH device on adherence to GH therapy, we carried out a retrospective longitudinal study of 46 GH deficient patients (24 boys, mean age of commencing GH therapy: 7.70±3.12 years) treated with recombinant GH therapy for 3 years, either with or without patient choice (n=28, 18, respectively). RESULTS The group comparison study for adherence, which evaluated the frequency of missed injections based on self-report, revealed that patient choice reduced the proportion of patients with low adherence 3 years after commencing GH therapy (33.3%-7.1%, p=0.042). Furthermore, this longitudinal study revealed that the patients with choice yielded significantly greater height standard deviation scores (SDS) (ΔHt SDS: 1.34±0.44 vs. 0.92±0.57, p=0.020) and insulin-like growth factor 1 (IGF-1) SDS (ΔIGF-1 SDS: 2.49±0.75 vs. 1.89±1.13, p=0.038) than those without choice. CONCLUSIONS These results indicate that patient choice might improve adherence to GH therapy, which improves the therapeutic effects of GH therapy.
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Lass N, Reinehr T. Low Treatment Adherence in Pubertal Children Treated with Thyroxin or Growth Hormone. Horm Res Paediatr 2016; 84:240-7. [PMID: 26279278 DOI: 10.1159/000437305] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Treatment outcome depends largely on treatment adherence (TA). However, studies analyzing TA in chronic endocrine diseases are scarce and controversial in childhood. PATIENTS AND METHODS We studied TA in 103 children treated subcutaneously with growth hormone (GH) and 97 children treated orally with thyroxin. TA was calculated based on the prescription refill rates. The number of GH injections was recorded by an autoinjector device in 23 children treated with GH. RESULTS The correlation between recorded TA and calculated TA based on prescription refill rates was very good (p < 0.001, r = 0.83). TA was lower (p < 0.01) in pubertal children compared to prepubertal children and in children self-administering their medication compared to those whose drug was administered by their parents, both in GH- and thyroxin-treated children. Overall, 67% of the pubertal children treated with GH and 58% of the pubertal children treated with thyroxin missed at least 1 dose per week. TA was higher (p < 0.001) in children with thyroxin treatment compared to children treated with recombinant human GH (8 vs. 26% missed >3 doses/week). DISCUSSION Puberty and self-administration of drugs were negative predictors of TA. Therefore, in puberty, prevention and treatment efforts should be undertaken to improve TA, especially when adolescents administer their drugs themselves.
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Affiliation(s)
- Nina Lass
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
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28
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Auer MK, Stieg MR, Hoffmann J, Stalla GK. Is insulin-like growth factor-I a good marker for treatment adherence in growth hormone deficiency in adulthood? Clin Endocrinol (Oxf) 2016; 84:862-9. [PMID: 26824335 DOI: 10.1111/cen.13030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/09/2015] [Accepted: 01/25/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE There is a paucity of studies on adherence to growth hormone treatment in growth hormone deficient (GHD) adults. Therefore, this study reports on adherence to GH-replacement therapy in adults with GHD, with a special focus on the course and potential predictors of nonadherence. DESIGN Retrospective single-centre cohort study. PATIENTS From the local patient database, 179 suitable patients with GHD were identified. MEASUREMENTS The primary outcome was adherence assessed by calculating the percentage of available prescription data in comparison with recommended GH dosages over a mean follow-up period of 92·4 months. Patients were categorized into five adherence categories ranging from <20% to >80%. RESULTS Mean overall adherence was 74·0%, with 52·9% of patients falling into the adherence group of >80% and 8·8% of <20%. There was a significant drop in adherence (9·8%) between the first and second years of treatment (P < 0·001). Patients with childhood-onset GHD were significantly less adherent to GH treatment than patients with adult-onset GHD (62·0% vs 77·0%, P = 0·012); however, this finding was no longer significant after including age as a covariate. Frequency of IGF-1 levels lying outside the age- and sex-specific reference range was not a good indicator for adherence. CONCLUSION Although overall adherence was relatively high in our study sample, there is a significant amount of patients who should be regarded as nonadherent. This applies in particular to younger patients. Treating physicians should be aware of the fact that IGF-1 levels do not seem to be a good indicator for adherence.
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Affiliation(s)
- Matthias K Auer
- RG Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Mareike R Stieg
- RG Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Janis Hoffmann
- RG Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Günter K Stalla
- RG Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
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29
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De Pedro S, Murillo M, Salinas I, Granada ML, Martinez M, Puig-Domingo M, Andreu A, Bel J. Variability in adherence to rhGH treatment: Socioeconomic causes and effect on children's growth. Growth Horm IGF Res 2016; 26:32-35. [PMID: 26774403 DOI: 10.1016/j.ghir.2015.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 09/28/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In children with growth disorders, mean final height is associated to poor adherence to Growth Hormone therapy. The primary goal of this study is to identify patients who do not adhere to GH therapy and determine the influence of adherence in response to the treatment. The role of serum IGF-I and influence of socio-economic factors on the therapeutic adherence will also be evaluated. METHODS 158 children under treatment with rhGH were included in the study. Age, gender, etiology, Tanner stage, duration of treatment, growth rate, IGF-I serum values, daily dose, and annual rhGH dose data were collected. Adherence to therapy was defined as moderate-to-poor when the patient had taken less than 92% of the prescribed medication. A subgroup of 106 patients completed a questionnaire to assess social and environmental effects. RESULTS Moderate-to-poor adherence to rhGH treatment was determined in 33.5% of study patients. A decrease in adherence was associated to treatment duration (p=0.001). A significant correlation was determined between adherence and height velocity (p=0.002) and IGF-I (p<0.0001) levels. Adherence rates were associated to the mother's educational level (p=0.007). CONCLUSION Poor adherence to GH therapy was observed in one-third of study patients, resulting in suboptimal growth. IGF-I levels can be helpful to identify patients with poor adherence to GH medication. Physicians should pay special attention to certain characteristics of the patient and their environment, and encourage desirable therapeutic compliance.
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Affiliation(s)
- Silvina De Pedro
- Department of Endocrinology and Nutrition, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
| | - Marta Murillo
- Department of Pediatric Endocrinology, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
| | - Isabel Salinas
- Department of Endocrinology and Nutrition, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
| | - Maria-Luisa Granada
- Clinical Biochemistry, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
| | - María Martinez
- Department of Pediatric Endocrinology, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
| | - Angels Andreu
- Pharmaceutics Department, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
| | - Joan Bel
- Department of Pediatric Endocrinology, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain
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30
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Kawashima R, Uchida M, Yamaki T, Ohtake K, Hatanaka T, Uchida H, Ueda H, Kobayashi J, Morimoto Y, Natsume H. Development of a Transnasal Delivery System for Recombinant Human Growth Hormone (rhGH): Effects of the Concentration and Molecular Weight of Poly-L-arginine on the Nasal Absorption of rhGH in Rats. Biol Pharm Bull 2015; 39:329-35. [PMID: 26725528 DOI: 10.1248/bpb.b15-00657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A novel system for delivering recombinant human growth hormone (rhGH) that is noninvasive and has a simple method of administration is strongly desired to improve the compliance of children. The aim of this study was to investigate the potential for the intranasal (i.n.) co-administration of rhGH with poly-L-arginine (PLA) as a novel delivery system by evaluating the effects of the concentration and molecular weight of PLA on the nasal absorption of rhGH. The influence of the formation of insoluble aggregates and a soluble complex in the dosage formulation on nasal rhGH absorption was also evaluated by size-exclusion chromatography and ultrafiltration. PLA enhanced the nasal absorption of rhGH at each concentration and molecular weight examined. Nasal rhGH absorption increased dramatically when the PLA concentration was 1.0 % (w/v) due to the improved solubility of rhGH in the formulation. A delay in rhGH absorption was observed when the molecular weight of PLA was increased. This appeared to be because the increase in molecular weight caused the formation of a soluble complex. It seems that the PLA concentration affects the absorption-enhancing effect on rhGH, while the molecular weight of PLA affects the time when the maximum plasma rhGH concentration was reached (Tmax) of rhGH after i.n. administration, mainly because of the interactions among rhGH, PLA, and additives. Therefore, the transnasal rhGH delivery system using PLA is considered to be a promising alternative to subcutaneous (s.c.) injection if these interactions are sufficiently controlled.
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Affiliation(s)
- Ryo Kawashima
- Faculty of Pharmaceutical Sciences, Josai University
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Growth in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children Study. Pediatr Nephrol 2014; 29:1987-95. [PMID: 24728472 PMCID: PMC4470271 DOI: 10.1007/s00467-014-2812-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/13/2014] [Accepted: 03/14/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growth failure is common among children with chronic kidney disease (CKD). We examined the relationship of growth parameters with glomerular filtration rate (GFR), CKD diagnosis, sex and laboratory results in children with CKD. METHODS Baseline data from 799 children (median age 11.0 years, median GFR 49.9 mL/min/1.73 m(2)) participating in the Chronic Kidney Disease in Children Study were examined. Growth was quantified by age-sex-specific height, weight, body mass index (BMI-age), and height-age-sex-specific BMI (BMI-height-age) standard deviation scores (SDS). RESULTS Median height and weight SDS were -0.55 [interquartile range (IQR) -1.35 to 0.19] and 0.03 (IQR -0.82 to 0.97), respectively. Girls with non-glomerular CKD were the shortest (median height SDS -0.83; IQR -1.62 to -0.02). Compared to those with a serum bicarbonate (CO2) level of ≥ 22 mEq/L, children with CO2 of <18 mEq/L had a height SDS that was on average 0.67 lower [95 % confidence interval (CI) -0.31 to -1.03]. Only 23 % of children with a height SDS of ≤-1.88 were prescribed growth hormone therapy. Forty-six percent of children with glomerular CKD were overweight or obese (BMI-height-age ≥ 85th percentile). CONCLUSIONS Growth outcomes in a contemporary cohort of children with CKD remain suboptimal. Interventions targeting metabolic acidosis and overcoming barriers to recombinant human growth hormone usage may improve growth in this population.
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