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Children’s adherence to GH therapy ‘suboptimal’
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Only 30% of children who are prescribed growth hormone therapy consistently adhere to treatment, according to study findings from researchers in Israel.
“The success of GH therapy depends on several factors, including drug dosage, patient’s diagnosis and adherence to treatment. ... Historically, adherence rates in the setting of long-term medication regimens average only 50%,” Joseph Meyerovitch, MD, associate clinical professor in the Sackler Faculty of Medicine at Tel Aviv University in Israel and chief pediatrician, community division, at Clalit Health Services, and colleagues wrote, noting that age, discomfort related to injection, family dynamics and the expensive cost of GH therapy are barriers to consistent adherence.
Researchers assessed adherence in a retrospective study of data from 2,263 children (41% girls; mean age, 8.3 years; 74% from secular Jewish families; 6.8% from ultra-Orthodox families; 18.9% from Arab families) who were treated with GH for more than 2 years from 2006 to 2015 and insured by Clalit Health Services, a state health organization in Israel. Good adherence was defined as purchasing prescribed GH at least 11 months in a year. Moderate adherence was met at 7 to 10 months and poor adherence was anything less than 7 months. Data were collected from a single central computerized data center.
The researchers reported that good adherence was found in only 30% of the study population vs. 53% with moderate adherence and 17% with poor adherence. When stratifying based on age, children younger than 8 years were less likely to adhere to GH than those aged 9 to 10 years, 11 to 12 years and at least 13 years. In addition, adherence rates declined over time (8.8 months in second year of treatment vs. 8.2 months in fifth year; P < .001).
Because GH can be prescribed for several conditions, the researchers examined whether adherence was affected by cause for prescription. They found that children with idiopathic short stature were most likely to have good adherence (P < .001). The lowest adherence rate was found in children with chronic renal failure (P < .001). Additionally, a direct association between the number of insulin-like growth factor I follow-up tests and adherence was observed. (P < .001).
The researchers also examined the effects of ethnicity, socioeconomic status and sex on adherence. They found a trend for an association with socioeconomic status and adherence (P = .061), and they noted that children in ultra-Orthodox families (n = 154) were at higher risk for poor adherence (OR = 2.16; 95% CI, 1.46-3.19).
“To improve long-term adherence in young patients, the children should be addressed during the process of GH treatment. We believe that as the patient gets older, he becomes more independent in treatment and [should] inject GH by himself,” the researchers wrote. “We recommend that at each clinic visit the physician will explain to the patient the rationale for the treatment in age-adjusted manner and address any concerns that the patient has. ... As the GH device [becomes more patient-friendly] and less painful, the adherence might be improved.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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