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Xia W, Wang T, Pan JY. Effects of different doses of long-acting growth hormone in treating children with growth hormone deficiency. World J Clin Cases 2023; 11:6715-6724. [PMID: 37901029 PMCID: PMC10600835 DOI: 10.12998/wjcc.v11.i28.6715] [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: 07/12/2023] [Revised: 08/03/2023] [Accepted: 09/04/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND With the improvement of economy and living standards, the attention paid to short stature in children has been increasingly highlighted. Numerous causes can lead to short stature in children, among which growth hormone deficiency (GHD) is a significant factor. AIM To investigate the long-term efficacy and safety of different doses of long-acting polyethylene glycol recombinant human growth hormone (PEG-rhGH) in the treatment of GHD in children. METHODS We selected 44 pediatric patients diagnosed with GHD who were treated at Wuhu First People's Hospital from 2014 to 2018. Total 23 patients were administered a high dose of long-acting PEG-rhGH at 0.2 mg/kg subcutaneously each week, forming the high-dose group. Meanwhile, 21 patients were given a lower dose of long-acting PEG-rhGH at 0.14 mg/kg subcutaneously each week, establishing the low-dose Group. The total treatment period was 2 years, during which we monitored the patients' height, annual growth velocity (GV), height standard deviation score (HtSDS), chronological age (CA), bone age (BA), and serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) before treatment and at 6 mo, 1 year, and 2 years after treatment initiation. We also monitored thyroid function, fasting plasma glucose, fasting insulin, and other side effects. Furthermore, we calculated the homeostatic model assessment for insulin resistance. RESULTS After 1 year of treatment, the GV, HtSDS, IGF-1, BA, and IGFBP-3 in both groups significantly improved compared to the pre-treatment levels (P < 0.05). Moreover, when comparing GV, HtSDS, IGF-1, BA, and IGFBP-3 between the two groups, there were no statistically significant differences either before or after the treatment (P > 0.05). During the treatment intervals of 0-1.0 years and 1.0-2.0 years, both patient groups experienced a slowdown in GV and a decline in HtSDS improvement (P < 0.05). CONCLUSION The use of PEG-rhGH in treating GHD patients was confirmed to be effective, with similar outcomes observed in both the high-dose group and low-dose groups, and no significant differences in the main side effects.
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Affiliation(s)
- Wei Xia
- Department of Pediatrics, The First People's Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Ting Wang
- Department of Pediatrics, The First People's Hospital of Wuhu, Wuhu 241000, Anhui Province, China
| | - Jia-Yan Pan
- Department of Pediatric Endocrinology, The First People's Hospital of Wuhu, Wuhu 241000, Anhui Province, China
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Rivolo S, Loftus J, Peter B, Fahey M, Kongnakorn T. Cost-effectiveness and cost-utility analysis of somatrogon once-weekly injections vs. daily growth hormone injection for treating paediatric growth hormone deficiency in Ireland. J Med Econ 2023; 26:963-972. [PMID: 37527156 DOI: 10.1080/13696998.2023.2228167] [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: 03/10/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Paediatric growth hormone deficiency (pGHD) manifests as growth failure associated with inadequate growth hormone (GH) production. Daily injections of recombinant human GH (dGH) [somatropin] is the current standard of care, which has been shown to be well tolerated and effective, but associated with suboptimal adherence, leading to reduced effectiveness. Somatrogon, a once-weekly injectable long-acting human GH, has demonstrated clinical non-inferiority and significantly lower life interference (i.e. treatment burden) vs. somatropin in two Phase 3 studies. This work evaluated cost-effectiveness and cost-utility of somatrogon vs dGHs from an Irish payer perspective. METHODS A Markov model was developed for patients starting somatrogon or dGHs treatment at 3-12 years and continuing up to achievement of near adult height (NAH), with growth driven by trial-based height velocity (HV) and treatment-specific adherence. Patients could discontinue treatment at the end of Year 1 (4%). DGH adherence (95.3%-65% over treatment duration) and adherence-growth relationship were based on published evidence. Higher Year 1 adherence of 4%, tapering over time, for somatrogon vs. dGHs was based on clinical consultation. Treatment costs, monitoring costs and costs due to different wastage types (device setting and adherence) were sourced from local data. Health utilities based on height and injection frequency were derived from published literature. Scenario analysis, deterministic and probabilistic sensitivity analysis were performed. RESULTS Somatrogon treatment led to 1.87-3.66 cm greater NAH gain and 0.21-0.50 higher quality adjusted life years (QALYs) vs. dGHs, across the base case and scenarios evaluated. Somatrogon treatment was associated with cost savings of €5,699-€21,974 and lower cost per cm gained vs. dGHs (€197-€527), per patient. Somatrogon was cost-effective vs. dGHs, with the result consistent across the sensitivity analyses conducted. CONCLUSION Somatrogon weekly injections were estimated to result in higher NAH, higher QALYs, lower overall costs and lower costs per cm gained than dGHs, in pGHD.
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Chae HW, Hwang IT, Lee JE, So CH, Rhie YJ, Lim JS, Kwon EB, Yi KH, Kim EY, Jo CK, Shim KS, Gil HY, Seong MJ, Nam CM, Moon JS, Hwang JS. Height outcomes in Korean children with idiopathic short stature receiving growth hormone treatment. Front Endocrinol (Lausanne) 2022; 13:925102. [PMID: 36157444 PMCID: PMC9490583 DOI: 10.3389/fendo.2022.925102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Growth hormone (GH) therapy's capacity to increase height velocity and height at the end of the study in children with idiopathic short stature (ISS) is controversial. We aimed to investigate the height standard deviation score (SDS) and height velocity of patients with ISS in Korea who received GH treatment. Methods We retrospectively reviewed and performed linear mixed model and survival analyses on data from 12 tertiary hospitals in Korea, including subjects diagnosed with ISS from January 2009 to September 2019, treated with GH therapy for more than 6 months, and who were at a pre-pubertal state at the time of diagnosis. Results We included 578 children (330 boys and 248 girls). The mean daily dose of GH in this study was 0.051 mg/kg, which was lower than the approved dose in Korea of 0.062 - 0.067 mg/kg. Height SDS was higher in patients who started treatment before the age of 6 years. The probability of reaching the target SDS (-1 SDS) from the beginning of treatment to 2-3 years after its start was higher in children starting treatment before the age of 6 years. The hazard ratio to reach the target SDS (-1 SDS) when using automatic pen or electronic devices was 1.727 times higher than that when using the needle and syringe device. Conclusion ISS patients should start GH treatment at an early age, and even lower-than-recommended drug doses may be effective. The selection of automatic pen or electronic device can have a positive effect on reaching the target height SDS.
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Affiliation(s)
- Hyun Wook Chae
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Il-Tae Hwang
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Ji-Eun Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Cheol Hwan So
- Department of Pediatrics, Wonkwang University Hospital, Jeollabuk-do, South Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, South Korea
| | - Eun Byul Kwon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, South Korea
| | - Kyung Hee Yi
- Department of Pediatrics, Wonkwang University Sanbon Medical Center, Gyeonggi-do, South Korea
| | - Eun Young Kim
- Department of Pediatrics, Chosun University Hospital, Gwangju, South Korea
| | - Chae-Ku Jo
- Department of Pediatrics, Dong-A University College of Medicine, Busan, South Korea
| | - Kye Shik Shim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Ha-Yeong Gil
- Medical Research Project Team, Internal Medicine (IM) Medical, Pfizer Korea, Seoul, South Korea
| | - Min-Jeong Seong
- Rare Disease, Medical Affairs, Pfizer Korea, Seoul, South Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Su Moon
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University Hospital, Gyeonggi-do, South Korea
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Sindi ST, Nazer NW, AlAgha AE. Impact of the COVID-19 pandemic on therapy compliance and lifestyle factors of patients with growth hormone deficiency. Saudi Med J 2022; 43:418-422. [PMID: 35414621 PMCID: PMC9998048 DOI: 10.15537/smj.2022.43.4.20210877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To recognize and assess treatment compliance in children and adolescents with growth hormone deficiency during the cronavirus disease-2019 (COVID-19) pandemic along with other lifestyle factors that might have been affected by the pandemic, such as diet, physical activity, sleep pattern, and screen time. METHODS This descriptive, cross-sectional study was carried out between March 2020-2021 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were collected through clinical interview questions. RESULTS The total sample size was 130 patients, 54 (41.5%) of whom were males and 76 (58.5%) were females. The mean age of the patients was 12.56±3.44 years. Comparisons of before and during the COVID-19 pandemic revealed significant changes in growth hormone therapy compliance (p=0.007), dietary changes (p=0.002) with an increase in vegetables and fruit consumption, a significant decrease in physical activity time (p<0.001), an increase in sleep time (p<0.001), and screen time (p<0.001). CONCLUSION The COVID-19 crisis had an impact on growth hormone therapy compliance, with a significant impact on other lifestyle factors such as dietary habits, physical activity, sleep time, and leisure screen time.
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Affiliation(s)
- Sulafa T. Sindi
- From the Department of Pediatrics (Sindi), King Abdulaziz University Hospital; from the Department of Pediatrics (AlAgha), Faculty of Medicine, King Abdulaziz University, and from the Department of Pediatrics (Nazer), King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia.
| | - Njood W. Nazer
- From the Department of Pediatrics (Sindi), King Abdulaziz University Hospital; from the Department of Pediatrics (AlAgha), Faculty of Medicine, King Abdulaziz University, and from the Department of Pediatrics (Nazer), King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulmoein E. AlAgha
- From the Department of Pediatrics (Sindi), King Abdulaziz University Hospital; from the Department of Pediatrics (AlAgha), Faculty of Medicine, King Abdulaziz University, and from the Department of Pediatrics (Nazer), King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia.
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Taghizadeh B, Jaafari MR, Zarghami N. New insight into the importance of formulation variables on parenteral growth hormone preparations: potential effect on the injection-site pain. Front Endocrinol (Lausanne) 2022; 13:963336. [PMID: 36263321 PMCID: PMC9576007 DOI: 10.3389/fendo.2022.963336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Reducing injection-site pain (ISP) in patients with chronic conditions such as growth hormone deficiency is a valuable strategy to improve patient compliance and therapeutic efficiency. Thus understanding different aspects of pain induction following subcutaneous injection of biotherapeutics and identifying the responsible factors are vital. Here we have discussed the effects of formulation's viscosity, concentration, osmolality, buffering agents, pH, and temperature as well as injection volume, dosing frequency, and different excipients on ISP following subcutaneous injection of commercially available recombinant human growth hormone products. Our literature review found limited available data on the effects of different components of parenteral rhGH products on ISP. This may be due to high cost associated with conducting various clinical trials to assess each excipient in the formulation or to determine the complex interactions of different components and its impact on ISP. Recently, conducting molecular dynamics simulation studies before formulation design has been recommended as an alternative and less-expensive approach. On the other hand, the observed inconsistencies in the available data is mainly due to different pain measurement approaches used in each study. Moreover, it is difficult to translate data obtained from animal studies to human subjects. Despite all these limitations, our investigation showed that components of parenteral rhGH products can significantly contribute to ISP. We suggest further investigation is required for development of long acting, buffer-free, preservative-free formulations. Besides, various excipients are currently being investigated for reducing ISP which can be used as alternatives for common buffers, surfactants or preservatives in designing future rhGH formulations.
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Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- *Correspondence: Nosratollah Zarghami,
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Tornincasa V, Dixon D, Le Masne Q, Martin B, Arnaud L, van Dommelen P, Koledova E. Integrated Digital Health Solutions in the Management of Growth Disorders in Pediatric Patients Receiving Growth Hormone Therapy: A Retrospective Analysis. Front Endocrinol (Lausanne) 2022; 13:882192. [PMID: 35846336 PMCID: PMC9281444 DOI: 10.3389/fendo.2022.882192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/06/2022] [Indexed: 01/31/2023] Open
Abstract
Digital health has seen rapid advancements over the last few years in helping patients and their healthcare professionals better manage treatment for a variety of illnesses, including growth hormone (GH) therapy for growth disorders in children and adolescents. For children and adolescents requiring such therapy, as well as for their parents, the treatment is longitudinal and often involves daily injections plus close progress monitoring; a sometimes daunting task when young children are involved. Here, we describe our experience in offering devices and digital health tools to support GH therapy across some 40 countries. We also discuss how this ecosystem of care has evolved over the years based on learnings and advances in technology. Finally, we offer a glimpse of future planned enhancements and directions for digital health to play a bigger role in better managing conditions treated with GH therapy, as well as model development for adherence prediction. The continued aim of these technologies is to improve clinical decision making and support for GH-treated patients, leading to better outcomes.
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Affiliation(s)
| | - David Dixon
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Quentin Le Masne
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Blaine Martin
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Lilian Arnaud
- Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
| | - Paula van Dommelen
- Department of Child Health, The Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
| | - Ekaterina Koledova
- Global Medical Affairs Cardiometabolic & Endocrinology, Merck Healthcare KGaA, Darmstadt, Germany
- *Correspondence: Ekaterina Koledova,
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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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Loftus J, Chen Y, Alvir JMJ, Chi L, Dasgupta S, Gupta A, Wajnrajch MP. Suboptimal adherence to daily growth hormone in a US real-world study: an unmet need in the treatment of pediatric growth hormone deficiency. Curr Med Res Opin 2021; 37:2141-2150. [PMID: 34569388 DOI: 10.1080/03007995.2021.1982682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate adherence to, and discontinuation of, somatropin treatment over 4 years in a US population-based study of children with pediatric growth hormone deficiency (pGHD). METHODS A retrospective cohort analysis of commercially insured patients ≥3 and <16 years, diagnosed with pGHD, newly treated with somatropin was conducted using Optum De-identified Clinformatics Data Mart. Index date was defined as the first prescription for somatropin between 01 July 2002 and 30 September 2019. Five non-exclusive patient cohorts were identified (>3, 12, 24, 36, and 48 months of post-index continuous enrollment). Suboptimal adherence was defined as medication possession ratio <80%. Discontinuation was defined as the date at which a gap of >60 days between somatropin fills first occurred. Cox proportional hazards regression was used to evaluate time to discontinuation. RESULTS In the 12-month cohort (n = 3091), mean age was 11.3 ± 2.9 years, 75.9% were male, 70.9% white, 9.4% Hispanic, 3.6% Asian, and 3.1% black. The proportion with suboptimal adherence at months 12 and 48 was 19.6% and 35.9%, respectively. Discontinuation occurred in 42.2% of patients. The rate of discontinuation (HR [95% CI]) was higher for age ≥10 (1.74 [1.53-1.98]), females (1.35 [1.21-1.50]), black and Hispanic race/ethnicity (1.50 [1.18-1.90] and 1.27 [1.09-1.49] compared to White) and obesity (1.69 [1.19-2.40]). CONCLUSION Suboptimal adherence increases with treatment duration, and risk of discontinuation is associated with age, female gender, black or Hispanic race/ethnicity, and obesity. Strategies that facilitate adherence among children at risk of discontinuation may improve clinical outcomes.
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Affiliation(s)
| | | | | | - Lei Chi
- Pfizer Inc, New York, NY, USA
| | | | | | - Michael P Wajnrajch
- Pfizer Inc, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
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Fernandez-Luque L, Al Herbish A, Al Shammari R, Argente J, Bin-Abbas B, Deeb A, Dixon D, Zary N, Koledova E, Savage MO. Digital Health for Supporting Precision Medicine in Pediatric Endocrine Disorders: Opportunities for Improved Patient Care. Front Pediatr 2021; 9:715705. [PMID: 34395347 PMCID: PMC8358399 DOI: 10.3389/fped.2021.715705] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Digitalization of healthcare delivery is rapidly fostering development of precision medicine. Multiple digital technologies, known as telehealth or eHealth tools, are guiding individualized diagnosis and treatment for patients, and can contribute significantly to the objectives of precision medicine. From a basis of "one-size-fits-all" healthcare, precision medicine provides a paradigm shift to deliver a more nuanced and personalized approach. Genomic medicine utilizing new technologies can provide precision analysis of causative mutations, with personalized understanding of mechanisms and effective therapy. Education is fundamental to the telehealth process, with artificial intelligence (AI) enhancing learning for healthcare professionals and empowering patients to contribute to their care. The Gulf Cooperation Council (GCC) region is rapidly implementing telehealth strategies at all levels and a workshop was convened to discuss aspirations of precision medicine in the context of pediatric endocrinology, including diabetes and growth disorders, with this paper based on those discussions. GCC regional investment in AI, bioinformatics and genomic medicine, is rapidly providing healthcare benefits. However, embracing precision medicine is presenting some major new design, installation and skills challenges. Genomic medicine is enabling precision and personalization of diagnosis and therapy of endocrine conditions. Digital education and communication tools in the field of endocrinology include chatbots, interactive robots and augmented reality. Obesity and diabetes are a major challenge in the GCC region and eHealth tools are increasingly being used for management of care. With regard to growth failure, digital technologies for growth hormone (GH) administration are being shown to enhance adherence and response outcomes. While technical innovations become more affordable with increasing adoption, we should be aware of sustainability, design and implementation costs, training of HCPs and prediction of overall healthcare benefits, which are essential for precision medicine to develop and for its objectives to be achieved.
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Affiliation(s)
| | | | - Riyad Al Shammari
- National Center for Artificial Intelligence, Saudi Data and Artificial Intelligence Authority, Riyadh, Saudi Arabia
| | - Jesús Argente
- Department of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| | - Bassam Bin-Abbas
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - David Dixon
- Connected Health and Devices, Merck, Ares Trading SA, Aubonne, Switzerland
| | - Nabil Zary
- Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Martin O. Savage
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, London, United Kingdom
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Labarta JI, Ranke MB, Maghnie M, Martin D, Guazzarotti L, Pfäffle R, Koledova E, Wit JM. Important Tools for Use by Pediatric Endocrinologists in the Assessment of Short Stature. J Clin Res Pediatr Endocrinol 2021; 13:124-135. [PMID: 33006554 PMCID: PMC8186334 DOI: 10.4274/jcrpe.galenos.2020.2020.0206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Assessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360° European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches.
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Affiliation(s)
- José I. Labarta
- University of Zaragoza, Children’s Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Unit of Endocrinology, Zaragoza, Spain,* Address for Correspondence: University of Zaragoza, Children’s Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Unit of Endocrinology, Zaragoza, Spain Phone: +34 976 765649 E-mail:
| | - Michael B. Ranke
- University of Tübingen, Children’s Hospital, Clinic of Pediatric Endocrinology, Tübingen, Germany
| | - Mohamad Maghnie
- University of Genova, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genova, Italy,IRCCS Instituto Giannina Gaslini, Department of Pediatrics, Genova, Italy
| | - David Martin
- University of Witten/Herdecke and Tübingen University, Tübingen, Germany
| | - Laura Guazzarotti
- University of Milan, Luigi Sacco Hospital, Clinic of Pediatric, Milan, Italy
| | - Roland Pfäffle
- University of Leipzig, Department of Pediatrics, Leipzig, Germany
| | | | - Jan M. Wit
- Leiden University Medical Centre, Department of Paediatrics, Leiden, Netherlands
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Dimitri P, Fernandez-Luque L, Banerjee I, Bergadá I, Calliari LE, Dahlgren J, de Arriba A, Lapatto R, Reinehr T, Senniappan S, Thomas-Teinturier C, Tsai MC, Anuar Zaini A, Bagha M, Koledova E. An eHealth Framework for Managing Pediatric Growth Disorders and Growth Hormone Therapy. J Med Internet Res 2021; 23:e27446. [PMID: 34014174 PMCID: PMC8176345 DOI: 10.2196/27446] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 01/19/2023] Open
Abstract
Background The use of technology to support health and health care has grown rapidly in the last decade across all ages and medical specialties. Newly developed eHealth tools are being implemented in long-term management of growth failure in children, a low prevalence pediatric endocrine disorder. Objective Our objective was to create a framework that can guide future implementation and research on the use of eHealth tools to support patients with growth disorders who require growth hormone therapy. Methods A total of 12 pediatric endocrinologists with experience in eHealth, from a wide geographical distribution, participated in a series of online discussions. We summarized the discussions of 3 workshops, conducted during 2020, on the use of eHealth in the management of growth disorders, which were structured to provide insights on existing challenges, opportunities, and solutions for the implementation of eHealth tools across the patient journey, from referral to the end of pediatric therapy. Results A total of 815 responses were collected from 2 questionnaire-based activities covering referral and diagnosis of growth disorders, and subsequent growth hormone therapy stages of the patient pathway, relating to physicians, nurses, and patients, parents, or caregivers. We mapped the feedback from those discussions into a framework that we developed as a guide to integration of eHealth tools across the patient journey. Responses focused on improved clinical management, such as growth monitoring and automation of referral for early detection of growth disorders, which could trigger rapid evaluation and diagnosis. Patient support included the use of eHealth for enhanced patient and caregiver communication, better access to educational opportunities, and enhanced medical and psychological support during growth hormone therapy management. Given the potential availability of patient data from connected devices, artificial intelligence can be used to predict adherence and personalize patient support. Providing evidence to demonstrate the value and utility of eHealth tools will ensure that these tools are widely accepted, trusted, and used in clinical practice, but implementation issues (eg, adaptation to specific clinical settings) must be addressed. Conclusions The use of eHealth in growth hormone therapy has major potential to improve the management of growth disorders along the patient journey. Combining objective clinical information and patient adherence data is vital in supporting decision-making and the development of new eHealth tools. Involvement of clinicians and patients in the process of integrating such technologies into clinical practice is essential for implementation and developing evidence that eHealth tools can provide value across the patient pathway.
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Affiliation(s)
- Paul Dimitri
- The Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Indraneel Banerjee
- Royal Manchester Children's Hospital, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Luis Eduardo Calliari
- Department of Paediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Jovanna Dahlgren
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Antonio de Arriba
- Paediatric Endocrinology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Risto Lapatto
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
| | - Senthil Senniappan
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Cécile Thomas-Teinturier
- Department of Pediatric Endocrinology, Assistance Publique - Hôpitaux de Paris, Université Paris Saclay, Hôpital Bicetre, Le Kremlin Bicêtre, France
| | - Meng-Che Tsai
- Department of Pediatrics, National Cheng Kung University, Tainan, Taiwan
| | | | - Merat Bagha
- Tiba Medical Inc, Beaverton, OR, United States
| | - Ekaterina Koledova
- Global Medical Affairs, Cardiometabolic and Endocrinology, Merck KGaA, Darmstadt, Germany
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12
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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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13
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Urakami T. Effectiveness of a smartphone application on medication adherence in children with short stature receiving GH therapy: A multicenter prospective cohort study (GTL-App). Clin Pediatr Endocrinol 2021; 30:85-92. [PMID: 33867668 PMCID: PMC8022037 DOI: 10.1297/cpe.30.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/11/2021] [Indexed: 12/04/2022] Open
Abstract
This multicenter prospective cohort study followed up Japanese children who had just
started GH therapy using a drug delivery device (GROWJECTOR® L) linked to a newly
developed smartphone application and analyzed precise medication adherence data stored in
GROWJECTOR® L to evaluate the usefulness of the application in improving GH therapy
adherence over a 24-wk observation period. Moreover, a questionnaire survey on GH therapy
and the smartphone application was conducted, and factors affecting adherence to GH
therapy were assessed. This study enrolled 60 children with short stature who had GH
deficiency or Turner syndrome or were small for gestational age from 28 Japanese medical
institutions and analyzed 57 of them. The median and mean adherence rates after 24 wk of
observation were 96% and 93%, respectively. Although adherence rates were significantly
lower from wk 16 to wk 20 than from wk 1 to wk 4, cumulative adherence rates remained high
throughout the observation period. The questionnaire analysis revealed that most patients
actively used the application. Overall, our results suggest that active discussion
regarding the development of healthcare systems that contribute toward improving the
patient quality of life is warranted.
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Lee JE, Lee KH, Park MJ, Yang S, Kim EY, Rhie YJ, Jung MH, Yang A, Kim SH, Chung LY, Ko SY, Lee YJ, Nedjatian N, Chung WY. The role of growth hormone device optimization in patient-reported outcomes: real-world evidence from South Korea. Expert Rev Med Devices 2021; 18:91-106. [PMID: 33307881 DOI: 10.1080/17434440.2021.1864324] [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: 10/22/2022]
Abstract
BACKGROUND Growth hormone (GH) treatment preference and adherence are affected by delivery device convenience, injection-site pain, confidence in correct dose administration, and device satisfaction. This survey investigated if switching device to NordiFlex® improved treatment experience in pediatric patients in South Korea. DESIGN AND METHODS Patients aged 4-≤18 years were surveyed. Participants were NordiFlex® users who previously used NordiLet®/other devices. Participants compared preference, self-reported adherence, satisfaction, perceived ease of use, and device subjective benefits (across four domains: ease of use, self-efficacy, minimal disruption of daily life, positive feelings about injections) of NordiFlex® vs. previous device. RESULTS Ninety-four patients were enrolled, of which 91.5% previously used NordiLet®. Significantly more patients preferred, and were more satisfied with NordiFlex® vs. previous device; mean score: 0.65 (95% confidence interval [CI]:0.41;0.88) and 0.61 (95% CI:0.36;0.85), respectively. Participants reported greater perceived ease of use (0.49 [95% CI:0.26;0.72]) and fewer missed injections (0.20 [95% CI:0.06;0.34], with NordiFlex® vs. previous device. Bivariate analysis showed significant associations between preference for NordiFlex® and higher scores on self-efficacy, ease of use, minimal disruption of daily life, and positive feelings about injection (all p < 0.001). CONCLUSION These results suggest that improvements in device features could be associated with improved treatment experience.
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Affiliation(s)
- Ji-Eun Lee
- Inha University Hospital, Incheon, Korea
| | | | - Mi Jung Park
- Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seung Yang
- Hanyang University Guri Hospital, Guri, Korea
| | | | | | - Min-Ho Jung
- The Catholic University of Korea Yeouido St Mary's Hospital, Seoul, Korea
| | - Aram Yang
- Kangbuk Samsung Hospital, Seoul, Korea
| | - Shin-Hye Kim
- Inje University Sanggye Paik Hospital, Seoul, Korea
| | | | | | - Young Ju Lee
- Medical Affairs, Novo Nordisk Pharma Korea Ltd, Seoul, Korea
| | - Navid Nedjatian
- Global Medical Affairs, Novo Nordisk Health Care AG, Zurich, Switzerland
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Juul Kildemoes R, Højby Rasmussen M, Agersø H, Overgaard RV. Optimal Monitoring of Weekly IGF-I Levels During Growth Hormone Therapy With Once-Weekly Somapacitan. J Clin Endocrinol Metab 2021; 106:567-576. [PMID: 33313798 PMCID: PMC7823237 DOI: 10.1210/clinem/dgaa775] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Somapacitan is a long-acting growth hormone (GH) in development for once-weekly treatment of GH deficiency (GHD). Optimal monitoring of insulin-like growth factor-I (IGF-I) levels must account for weekly IGF-I fluctuations following somapacitan administration. OBJECTIVE To develop and assess the reliability of linear models for predicting mean and peak IGF-I levels from samples taken on different days after dosing. DESIGN A pharmacokinetic/pharmacodynamic model was used to simulate IGF-I data in adults and children following weekly somapacitan treatment of GHD. SETTING AND PATIENTS 39 200 IGF-I profiles were simulated with reference to data from 26 adults and 23 children with GHD. INTERVENTION(S) The simulated dose range was 0.02 to 0.12 mg/kg for adults and 0.02 to 0.16 mg/kg for children. Simulated data with >4 average standard deviation score were excluded. MAIN OUTCOME MEASURE(S) Linear models for predicting mean and peak IGF-I levels based on IGF-I samples from different days after somapacitan dose. RESULTS Robust linear relationships were found between IGF-I sampled on any day after somapacitan dose and the weekly mean (R2 > 0.94) and peak (R2 > 0.84). Prediction uncertainties were generally low when predicting mean from samples taken on any day (residual standard deviation [RSD] ≤ 0.36) and peak from samples taken on day 1 to 4 (RSD ≤ 0.34). IGF-I monitoring on day 4 and day 2 after dose provided the most accurate estimate of IGF-I mean (RSD < 0.2) and peak (RSD < 0.1), respectively. CONCLUSIONS Linear models provided a simple and reliable tool to aid optimal monitoring of IGF-I by predicting mean and peak IGF-I levels based on an IGF-I sample following dosing of somapacitan. A short visual summary of our work is available (1).
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Affiliation(s)
| | | | - Henrik Agersø
- Global Development, Novo Nordisk A/S, Bagsværd, Denmark
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16
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Straetemans S, Rooman R, De Schepper J. Is a Two-Year Growth Response to Growth Hormone Treatment a Better Predictor of Poor Adult Height Outcome Than a First-Year Growth Response in Prepubertal Children With Growth Hormone Deficiency? Front Endocrinol (Lausanne) 2021; 12:678094. [PMID: 34140931 PMCID: PMC8204852 DOI: 10.3389/fendo.2021.678094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The first year response to growth hormone (GH) treatment is related to the total height gain in GH treated children, but an individual poor first year response is a weak predictor of a poor total GH effect in GH deficient (GHD) children. We investigated whether an underwhelming growth response after 2 years might be a better predictor of poor adult height (AH) outcome after GH treatment in GHD children. DESIGN AND METHODS Height data of GHD children treated with GH for at least 4 consecutive years of which at least two prepubertal and who attained (near) (n)AH were retrieved from the Belgian Register for GH treated children (n = 110, 63% boys). In ROC analyses, the change in height (ΔHt) SDS after the first and second GH treatment years were tested as predictors of poor AH outcome defined as: (1) nAH SDS <-2.0, or (2) nAH SDS minus mid-parental height SDS <-1.3, or (3) total ΔHt SDS <1.0. The cut-offs for ΔHt SDS and its sensitivity at a 95% specificity level to detect poor AH outcome were determined. RESULTS Eleven percent of the cohort had a total ΔHt SDS <1.0. ROC curve testing of first and second years ΔHt SDS as a predictor for total ΔHt SDS <1.0 had an AUC >70%. First-year ΔHt SDS <0.41 correctly identified 42% of the patients with poor AH outcome at a 95% specificity level, resulting in respectively 5/12 (4.6%) correctly identified poor final responders and 5/98 (4.5%) misclassified good final responders (ratio 1.0). ΔHt SDS after 2 prepubertal years had a cut-off level of 0.65 and a sensitivity of 50% at a 95% specificity level, resulting in respectively 6/12 (5.5%) correctly identified poor final responders and 5/98 (4.5%) misclassified good final responders (ratio 1.2). CONCLUSION In GHD children the growth response after 2 prepubertal years of GH treatment did not meaningfully improve the prediction of poor AH outcome after GH treatment compared to first-year growth response parameters. Therefore, the decision to re-evaluate the diagnosis or adapt the GH dose in case of poor response after 1 year should not be postponed for another year.
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Affiliation(s)
- Saartje Straetemans
- Department of Pediatric Endocrinology, Maastricht University Medical Center, Maastricht, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Putte, Netherlands
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- *Correspondence: Saartje Straetemans,
| | | | - Jean De Schepper
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- Department of Pediatric Endocrinology, University Hospital Brussels, Brussels, Belgium
- Department of Pediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
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17
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Miller BS, Velazquez E, Yuen KCJ. Long-Acting Growth Hormone Preparations - Current Status and Future Considerations. J Clin Endocrinol Metab 2020; 105:5611083. [PMID: 31676901 PMCID: PMC7755139 DOI: 10.1210/clinem/dgz149] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Long-acting GH (LAGH) preparations are currently being developed in an attempt to improve adherence. The profile of GH action following administration of LAGH raises practical questions about clinical monitoring and long-term safety and efficacy of these new therapeutic agents. METHODS Recent literature and meeting proceedings regarding LAGH preparations are reviewed. RESULTS Multiple LAGH preparations are currently at various stages of development, allowing for decreased GH injection frequency from daily to weekly, biweekly, or monthly. Following administration of LAGH, the serum peak and trough GH and IGF-I levels vary depending upon the mechanism used to prolong GH action. Randomized, controlled clinical trials of some LAGH preparations have reported non-inferiority compared with daily recombinant human GH (rhGH) for improved growth velocity and body composition in children and adults with GH deficiency (GHD), respectively. No significant LAGH-related adverse events have been reported during short-term therapy. CONCLUSION Multiple LAGH preparations are proceeding through clinical development with some showing promising evidence of short-term clinical efficacy and safety in children and adults with GHD. The relationship of transient elevations of GH and IGF-I following administration of LAGH to efficacy and safety remain to be elucidated. For LAGH to replace daily rhGH in the treatment of individuals with GHD, a number of practical questions need to be addressed including methods of dose adjustment, timing of monitoring of IGF-I, safety, efficacy, and cost-effectiveness. Long-term surveillance of efficacy and safety of LAGH preparations will be needed to answer these clinically relevant questions.
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Affiliation(s)
- Bradley S Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Correspondence and Reprint Requests: Bradley S. Miller, MD, PhD, 8952D, MB671 East Bldg, Division of Endocrinology, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454. E-mail:
| | - Eric Velazquez
- Division of Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Kevin C J Yuen
- Departments of Neuroendocrinology and Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine, Phoenix, Arizona
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Wit JM, Deeb A, Bin-Abbas B, Al Mutair A, Koledova E, Savage MO. Achieving Optimal Short- and Long-term Responses to Paediatric Growth Hormone Therapy. J Clin Res Pediatr Endocrinol 2019; 11:329-340. [PMID: 31284701 PMCID: PMC6878339 DOI: 10.4274/jcrpe.galenos.2019.2019.0088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023] Open
Abstract
It is over sixty years since the first administration of human growth hormone (GH) to children with GH deficiency, and over thirty years since recombinant human GH has been available for treatment of GH deficiency and a wider range of non-GH deficiency disorders. From a diagnostic perspective, genetic analysis, using single gene or Sanger sequencing and more recently next generation or whole exome sequencing, has brought advances in the diagnosis of specific causes of short stature, which has enabled therapy to be targeted more accurately. Genetic discoveries have ranged from defects of pituitary development and GH action to abnormalities in intracellular mechanisms, paracrine regulation and cartilage matrix formation. The strategy of GH therapy using standard doses has evolved to individualised GH dosing, depending on diagnosis and predictors of growth response. Evidence of efficacy of GH in GH deficiency, Turner syndrome and short children born small for gestational age is reviewed. The importance of critical assessment of growth response is discussed, together with the recognition and management of a poor or unsatisfactory growth response and the organisational issues related to prevention, detection and intervention regarding suboptimal adherence to GH therapy.
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Affiliation(s)
- Jan M. Wit
- Leiden University Medical Centre, Department of Paediatrics, Leiden, Netherlands
| | - Asma Deeb
- Mafraq Hospital, Clinic of Paediatric Endocrinology, Abu Dhabi, United Arab Emirates
| | - Bassam Bin-Abbas
- King Faisal Specialist Hospital and Research Center, Department of Paediatrics, Riyadh, Saudi Arabia
| | - Angham Al Mutair
- King Abdullah Specialised Children’s Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research, Clinic of Paediatrics, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science, Clinic of Paediatrics, Riyadh, Saudi Arabia
| | | | - Martin O. Savage
- William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, London, United Kingdom
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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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Acerini CL, Segal D, Criseno S, Takasawa K, Nedjatian N, Röhrich S, Maghnie M. Shared Decision-Making in Growth Hormone Therapy-Implications for Patient Care. Front Endocrinol (Lausanne) 2018; 9:688. [PMID: 30524377 PMCID: PMC6262035 DOI: 10.3389/fendo.2018.00688] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022] Open
Abstract
Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT. Improved adherence to therapy in this way may consequently positively impact treatment outcomes for patients. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM, and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.
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Affiliation(s)
- Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Carlo L. Acerini
| | - David Segal
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherwin Criseno
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kei Takasawa
- Department of Paediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Mohamad Maghnie
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
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Hauffa BP, Touraine P, Urquhart-Kelly T, Koledova E. Managing Transition in Patients Treated with Growth Hormone. Front Endocrinol (Lausanne) 2017; 8:346. [PMID: 29312142 PMCID: PMC5732460 DOI: 10.3389/fendo.2017.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/28/2017] [Indexed: 11/27/2022] Open
Abstract
Growth hormone (GH) promotes growth in children, but is also essential for bone strength, body composition, metabolic factors, such as lipid profile, and maintenance of quality of life. The Merck KGaA (Germany) funded "360° GH in Europe" meeting, held in Lisbon, Portugal, in June 2016, comprised three sessions entitled "Short Stature Diagnosis and Referral," "Optimizing Patient Management and Adherence," and "Managing Transition." The scientific program covered all stages of pediatric GH treatment, and reported here are the outcomes of the third session of the meeting, which considered transition from pediatric GH treatment to teenage and young adult GH therapy. A large number of patients with chronic diseases, including GH deficiency, drop out of therapy during the transition period. Multiple factors are associated with this, such as lack of understanding of the disease process, insufficient knowledge of treatment options, the patient becoming more independent, and requirement for interaction with a new set of health-care workers. Education regarding disease management and treatment options should be provided from an early age and right through the transition period. However, endocrine specialists will view the transition period differently, depending on whether they are pediatric endocrinologists who mainly deal with congenital diseases, in which auxology is important, or adult endocrinologists who are more concerned with body composition and metabolic factors. View points of both a pediatric and an adult endocrine specialist are presented, together with a case study outlining practical aspects of transition. It was noted in the meeting discussion that having one person to guide a patient through transition from an early age is important, but may be constrained by various factors such as finances, and options will differ by country.
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Affiliation(s)
- Berthold P. Hauffa
- Department of Pediatric Endocrinology, University of Duisburg-Essen, Essen, Germany
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
| | - Tanya Urquhart-Kelly
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ekaterina Koledova
- Global Medical Affairs, Merck KGaA, Darmstadt, Germany
- *Correspondence: Ekaterina Koledova,
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Maghnie M, Labarta JI, Koledova E, Rohrer TR. Short Stature Diagnosis and Referral. Front Endocrinol (Lausanne) 2017; 8:374. [PMID: 29375479 PMCID: PMC5768898 DOI: 10.3389/fendo.2017.00374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 01/15/2023] Open
Abstract
The "360° GH in Europe" meeting, which examined various aspects of GH diseases, was held in Lisbon, Portugal, in June 2016. The Merck KGaA (Germany) funded meeting comprised three sessions entitled "Short Stature Diagnosis and Referral," "Optimizing Patient Management," and "Managing Transition." Each session had three speaker presentations, followed by a discussion period, and is reported as a manuscript, authored by the speakers. The first session examined current processes of diagnosis and referral by endocrine specialists for pediatric patients with short stature. Requirements for referral vary widely, by country and by patient characteristics such as age. A balance must be made to ensure eligible patients get referred while healthcare systems are not over-burdened by excessive referrals. Late referral and diagnosis of non-GH deficiency conditions can result in increased morbidity and mortality. The consequent delays in making a diagnosis may compromise the effectiveness of GH treatment. Algorithms for growth monitoring and evaluation of skeletal disproportions can improve identification of non-GH deficiency conditions. Performance and validation of guidelines for diagnosis of GH deficiency have not been sufficiently tested. Provocative tests for investigation of GH deficiency remain equivocal, with insufficient information on variations due to patient characteristics, and cutoff values for definition differ not only by country but also by the assay used. When referring and diagnosing causes of short stature in pediatric patients, clinicians need to rely on many factors, but the most essential is clinical experience.
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Affiliation(s)
- Mohamad Maghnie
- Department of Pediatrics, IRCCS Children’s Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - José I. Labarta
- Endocrinology Unit, Children’s Hospital Miguel Servet, University of Zaragoza, Zaragoza, Spain
| | | | - Tilman R. Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg, Germany
- *Correspondence: Tilman R. Rohrer,
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