ISSN: 1308-5727 | E-ISSN: 1308-5735
Volume: 16 Issue: 4 Year: 2024
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Turkish Society for Pediatric Endocrinology and Diabetes
Adherence to Growth Hormone Treatment in Children During the COVID-19 Pandemic [J Clin Res Pediatr Endocrinol]
J Clin Res Pediatr Endocrinol. 2024; 16(3): 256-263 | DOI: 10.4274/jcrpe.galenos.2024.2023-10-8

Adherence to Growth Hormone Treatment in Children During the COVID-19 Pandemic

Erdal Eren1, Semra Çetinkaya2, Yasemin Denkboy Öngen1, Ummahan Tercan3, Şükran Darcan4, Hande Turan5, Murat Aydın6, Fatma Yavuzyılmaz7, Fatih Kilci8, Beray Selver Eklioğlu9, Nihal Hatipoğlu10, Kübra Yüksek Acinikli11, Zerrin Orbak12, Emine Çamtosun13, Şenay Savaş Erdeve2, Emrullah Arslan4, Oya Ercan5, Feyza Darendeliler3
1Bursa Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
2University of Health Sciences Turkey, Ankara Dr. Sami Ulus Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
3İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
4Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
5İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
6Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
7Düzce University Faculty of Medicine, Department of Endocrinology, Düzce, Turkey
8Kocaeli University Faculty of Medicine, Department of Endocrinology, Kocaeli, Turkey
9Necmettin Erbakan University, Meram Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
10Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
11Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
12Atatürk University Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
13İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey

INTRODUCTION: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated.
METHODS: This was a multicenter survey study that was sent to pediatric endocrinologists during the pandemic period (June-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, missed dose data and the causes in the recent year (after the onset of the pandemic) were questioned. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% non-adherence).
RESULTS: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and “others“ (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 μg/kg, the annual growth rate was 1.15 standard deviation score (minimum -2.74, maximum 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for non-adherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as non-adherence rate increased.
DISCUSSION AND CONCLUSION: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.

Keywords: Children, growth hormone, adherence, COVID-19, pandemic

Corresponding Author: Erdal Eren, Türkiye
Manuscript Language: English
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