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. 2011 Jan 31;6(1):e16223.
doi: 10.1371/journal.pone.0016223.

Non-compliance with growth hormone treatment in children is common and impairs linear growth

Wayne S Cutfield  1 , José G B Derraik, Alistair J Gunn, Kyle Reid, Theresa Delany, Elizabeth Robinson, Paul L Hofman
Affiliations

Non-compliance with growth hormone treatment in children is common and impairs linear growth

Wayne S Cutfield et al. PLoS One. .

Abstract

Background: GH therapy requires daily injections over many years and compliance can be difficult to sustain. As growth hormone (GH) is expensive, non-compliance is likely to lead to suboptimal growth, at considerable cost. Thus, we aimed to assess the compliance rate of children and adolescents with GH treatment in New Zealand.

Methods: This was a national survey of GH compliance, in which all children receiving government-funded GH for a four-month interval were included. Compliance was defined as ≥ 85% adherence (no more than one missed dose a week on average) to prescribed treatment. Compliance was determined based on two parameters: either the number of GH vials requested (GHreq) by the family or the number of empty GH vials returned (GHret). Data are presented as mean ± SEM.

Findings: 177 patients were receiving GH in the study period, aged 12.1 ± 0.6 years. The rate of returned vials, but not number of vials requested, was positively associated with HVSDS (p < 0.05), such that patients with good compliance had significantly greater linear growth over the study period (p<0.05). GHret was therefore used for subsequent analyses. 66% of patients were non-compliant, and this outcome was not affected by sex, age or clinical diagnosis. However, Maori ethnicity was associated with a lower rate of compliance.

Interpretation: An objective assessment of compliance such as returned vials is much more reliable than compliance based on parental or patient based information. Non-compliance with GH treatment is common, and associated with reduced linear growth. Non-compliance should be considered in all patients with apparently suboptimal response to GH treatment.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Height velocity standard deviation scores (HVSDS) over 6–8 months according to the level of compliance with GH treatment: High (n = 30) missed ≤1 dose/week, Medium (n = 51) missed >1 and <3 doses/week, and Low (n = 29) missed ≥3 doses/week.
Data are mean ± SEM. **p<0.01, ***p<0.001 vs High.
See this image and copyright information in PMC

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