Background: Adherence to GH treatment is a challenge.
Objective and hypotheses: We analysed the impact of treatment duration, treatment success, treatment indication, age, gender, pubertal stage, and height on treatment adherence (TA) to optimise treatment success.
Method: Based on the easypod autoinjector used in the Saizen-online prospective, multicenter, open-label, noninterventional study we analyzed TA in 6 months periods. TA was evaluated using proposed cut-offs (good adherence: <1 missed dose/week; medium adherence: 13 missed doses/week; poor adherence: >3 missed doses/week)1.
Results: 168 children treated with GH (71% GH deficiency, 7% Turner-Syndrome, 2% chronic renal insufficiency, 20% small-for-gestational age) were included (641 6-months observations periods). TA did not differ significantly between treatment indications (P=0.713) or gender (P=0.167). Younger age, prepubertal stage, and lower height-SDS were associated with better TA, while better treatment success and longer treatment duration were related to lower TA (table 1).
|Good adherence||Medium adherence||Poor adherence||P-value|
|Number of 6-months observation periods||373 (58.2%)||135 (21.1%)||133 (20.7%)|
|Actual height-SDS||−1.9±1.1||−1.7±1.2||−1.3±1.3||<0.0011,3; 0.0382; 0.0174|
|Treatment success (actual height-SDS height-SDS at onset of GH treatment)||+0.8 (IQR 0.21.4)||+0.7 (IQR 0.21.3)||+1.0 (IQR 0.51.5)||0.0041; 0.0023; 0.0054|
|Treatment duration (y)||1.8 (IQR 0.83.6)||3.0 (IQR 1.54.5)||2.5 (IQR 1.63.6)||<0.001 1,2,3|
|Data as n (%), mean±1 S.D., or median and interquartile range (IQR); P-values: 1) overall; 2) good versus medium; 3) good versus poor; 4) medium vs poor TA, Fishers exact, WilcoxonMannWhitney and KruskalWallis tests were used as adequate.|
Conclusion: Especially in pubertal children with good treatment success so far, TA should be critically reviewed.
Funding: This work was supported by a grant from Merck Serono GmbH, Darmstadt Germany. Study design, data collection and analysis, decision to publish, and preparation of the manuscript are solely the responsibility of the authors.
01 Oct 2015 - 03 Oct 2015