Abstract
BackgroundRecombinant human growth hormone (rhGH) therapy is an effective treatment for children with growth disorders. However, poor outcomes are often associated with suboptimal adherence to treatment.ObjectiveThe easypod connected injection device records and transmits injection settings and dose data from patients receiving rhGH. In this study, we evaluated adherence to rhGH treatment, and associated growth outcomes, in Latin American patients.MethodsAdherence and growth data from patients aged 2-18 years from 12 Latin American countries were analyzed. Adherence data were available for 6207 patients with 2,449,879 injections, and growth data were available for 497 patients with 2232 measurements. Adherence was categorized, based on milligrams of rhGH injected versus milligrams of rhGH prescribed, as high (≥85%), intermediate (>56%-<85%), or low (≤56%). Transmission frequency was categorized as high (≥1 per 3 months) or low (<1 per 3 months). Chi-square tests were applied to study the effect of pubertal status at treatment start and sex on high adherence, and to test differences in frequency transmission between the three adherence levels. Multilevel linear regression techniques were applied to study the effect of adherence on observed change in height standard deviation score (∆HSDS).ResultsOverall, 68% (4213/6207), 25% (n=1574), and 7% (n=420) of patients had high, intermediate, and low adherence, respectively. Pubertal status at treatment start and sex did not have a significant effect on high adherence. Significant differences were found in the proportion of patients with high transmission frequency between high (2018/3404, 59%), intermediate (608/1331, 46%), and low (123/351, 35%) adherence groups (P<.001). Adherence level had a significant effect on ∆HSDS (P=.006). Mean catch-up growth between 0-24 months was +0.65 SD overall (+0.52 SD in patients with low/intermediate monthly adherence and +0.69 SD in patients with high monthly adherence). This difference translated into 1.1 cm greater catch-up growth with high adherence.ConclusionsThe data extracted from the easypod Connect ecosystem showed high adherence to rhGH treatment in Latin American patients, with positive growth outcomes, indicating the importance of connected device solutions for rhGH treatment in patients with growth disorders.
Highlights
Adherence to long-term pharmacological treatments, such as growth hormone (GH) therapy for growth disorders, is an area with great potential for improvement [1,2]
The data extracted from the easypod Connect ecosystem showed high adherence to Recombinant human growth hormone (rhGH) treatment in Latin American patients, with positive growth outcomes, indicating the importance of connected device solutions for rhGH treatment in patients with growth disorders
Analysis of the data extracted from easypod Connect showed high adherence to rhGH treatment in Latin American patients, with positive growth outcomes
Summary
Adherence to long-term pharmacological treatments, such as growth hormone (GH) therapy for growth disorders, is an area with great potential for improvement [1,2]. Poor long-term adherence to GH treatment is known to affect final adult height and additional clinical outcomes in children with growth disorders [3]. Enthusiasm and motivation to adhere to treatment may decrease over time because the long-term benefits of GH treatment are not immediately obvious to children, and administering daily subcutaneous injections places a significant burden on them and their parents/caregivers [3,4,5]. Adherence to GH treatment in the real-world setting has always been difficult to monitor, given the use of unreliable proxy methods such as patient testimony or records of prescriptions filled/vials counted [4,5]. Poor outcomes are often associated with suboptimal adherence to treatment
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