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Adolescence, low parental education linked with treatment non-adherence in children with growth disorders
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Researchers in Italy report adherence to recombinant growth hormone therapy remains a major problem among children with growth disorders. Based on their findings, they suggest pediatric endocrinologists annually assess treatment adherence among patients treated with growth hormone.
“From 1985, the availability of the [recombinant growth hormone] has increased the possibility of treating a larger number of children and adolescents with a wide range of different conditions, with the aim of normalizing linear growth as quickly as possible and attaining a ‘normal adult height,’ whilst minimizing risks and costs,” Francesca Bagnasco, PhD, of the epidemiology and biostatistics unit at Istituto Giannina Gaslini, Genova, Italy, and colleagues wrote. “Drug adherence in pediatrics is unique because of the involvement of a third party, ie, the parent/guardian, and because the child is often unaware of the purpose of the medication and is reluctant to take it. Depending on the definition and methods used, suboptimal adherence to GH treatment has been reported to vary between 18% and 95%.”
The researchers evaluated the self-reported prevalence of adherence to GH therapy among children and adolescents treated at 46 pediatric centers in Italy. Children aged between 6 and 16 years who were treated with recombinant GH for at least 6 months (n=1,007) were included. The person in charge of each patient’s injection filled out a questionnaire, and researchers used multivariable logistic regression analysis to identify associations with adherence. Most questionnaires were completed by parents (76.6%).
Nearly one-fourth (24.4%) of patients missed at least one injection during a typical week, which qualified them as non-adherent, Bagnasco and colleagues reported. Being away from home was the most commonly reported explanation for missing an injection (33.3%), followed by forgetfulness (24.7%), not feeling well (12.9%) and pain (10.3%).
Many factors were associated with non-adherence, according to the researchers. These included adolescence, longer duration of treatment, lower levels of education among parents, a need to convince the child to inject and low awareness of the consequences of non-adherence. Conversely, injection by the parent, less pain, confidence in the dose and overall satisfaction with treatment were all associated with better adherence.
“There is a need for multifactorial and effective interventions to improve adherence by combining risk-assessment and screening of poor adherent patients,” the researchers wrote. “The choice of device, training family and patients, perception of parents’ and patients’ behavior and their support are determinant factors. Increasing awareness and reassessment of treatment adherence on an annual basis should be part of clinical practice of pediatric endocrinologists involved with [recombinant growth hormone] treatment.” – by Andy Polhamus
Disclosure: Bagnasco reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.
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