Survey to Investigate Adherence to Growth Hormone Treatment in Children: The Impact of COVID-19 Pandemic

ABSTRACT

Introduction: Treatment adherence is crucial for the success of Growth Hormone (GH) therapy. Non-adherence rates have varied over a wide range from 5% to 80% in the literature. Several factors may have an impact on treatment adherence. Besides, with the COVID-19 pandemic that affected the whole world, there were problems with the hospital admission and routine controls of the patients who used GH treatment. Objective(s) The survey's primary objective is to investigate adherence to treatment in patients with GH. The survey will also investigate potential problems in GH treatment during the pandemic. Material(s) and Method(s) The survey was sent to pediatric endocrinologists. Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, who administers the therapy (mother and father, patient), duration of missed doses, reasons for missed doses as well as problems associated with GH therapy, and missed dose data in the recent year (after the onset of the pandemic) and causes were asked. The treatment adherence category was determined based on missed dose rates over the past month (0 to 5%, full adherence;5.1 to 10% moderate adherence;>10% non-adherence). Result(s) 427 cases from thirteen centers were evaluated. The median age of diagnosis of the cases (56.2% male) was 8.5 (0.13-16) years. GH treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), and SGA (2.8%), and other (6.8%). GH therapy was administered by 70% parents and 30% patients. Mean daily dose was 32.3 mcg/kg, the annual growth rate was 7.52+/-2.7 cm. GH adherence rate was good (70.3%), moderate (14.7%), and poor (15%), respectively. The reasons for non-adherence were mainly due to forgetting, being tired, inability to access medication, and pen problems. It was noteworthy that the COVID-19 pandemic had a negative effect on adherence in 22%. The problem with an appointment, taking the medication, and anxiety about going to the hospital were the main reasons. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased statistically when the patient administered the treatment, increased age, the duration of the treatment, and COVID-19 pandemia. A non-statistical decrease was found in the annual growth rate as the skip rate increased. Conclusion(s) During the COVID-19 pandemic, poor adherence was found to be 15%, and the duration of hormone use and advanced age are important factors. The pandemic period negatively affected compliance.