Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients\u2018 perspective

Ilonka Kreitschmann-Andermahr,Martin Bidlingmaier,Janine Szybowicz,Agnieszka Grzywotz,Christian J Strasburger,Katharina Schilbach,Wolfram Karges,Bernadette Schröder,Janina Sauerwald,Sonja Siegel,Kathrin Zopf,Nicole Unger,Christine Streetz-Van Der Werf,Heide Sommer

doi:10.1007/s11102-020-01046-y

Abstract

IntroductionWhile reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients. Against the background of the adverse medical sequelae of untreated severe GH deficiency (GHD) in adults, we explored adherence to GH-Rx and associated factors in this patient group.MethodCross-sectional analysis including 107 adult patients with severe GHD on GH-Rx, 15 untreated GDH patients and 19 who had discontinued therapy. Patients completed self-developed ad hoc surveys on adherence to medication and GH-Rx, specific beliefs about GH-Rx, side effects and burden of injection, reasons for never receiving or dropping out of therapy, respectively.ResultsAdherence to GH-Rx was high (mean 15.8/18 points on the self-developed adherence score) and significantly correlated with general medication adherence. Higher age was significantly associated with better adherence to GH-Rx, while injection side effects, duration of treatment or device used were not. The most frequent reasons for not being on GH-Rx apart from medical reasons included fear of side effects, lack of belief in treatment effects and dislike of injections. In patients not on GH-Rx, the proportion of patients in employment was significantly smaller than in the treatment group, despite similar age and comorbidities.ConclusionsAdherence to GH-Rx was high for those patients on therapy. Instead of focusing on improving adherence in those adults already on GH-Rx, efforts should be undertaken to ally fear of side effects and provide education on positive treatment effects for those eligible but not receiving therapy.

Highlights

While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients
We explored motivation for and adherence to recombinant human GH (rhGH) replacement in a large cohort of patients with biochemically proven severe GH deficiency (GHD)
Three quarters of our 141 patients (75.9%) currently received hrGH replacement while the rest either declined or dropped out of rhGH therapy, which is similar to the distribution of treated versus untreated patients in another recent smaller monocentric study on adherence to rhGH in adults by Amereller et al [14]

Summary

Introduction

While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients. Against the background of the adverse medical sequelae of untreated severe GH deficiency (GHD) in adults, we explored adherence to GH-Rx and associated factors in this patient group. Adherence has been defined by the World Health Organization as the extent to which a persons behavior - taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider [1] It is well known, that lack of adherence reduces the effects of therapies and negatively influences cost efficiency of medical interventions. Against the background of the adverse medical sequelae of untreated severe GHD in adults, we conducted the following crosssectional questionnaire study in order to explore adherence to GH-Rx and associated factors in this patient group

Methods

Results

Conclusion