Endocrine Abstracts

Background and aims: Non-adherence to daily subcutaneous GH (r-HGH) administration may account for discrepancies between dose prescription, growth response and serum IGF1 levels but is difficult to determine. The electronic r-HGH auto-injector Easypod device has the only inbuilt retrievable dosing record, with which we aimed to assess adherence.

Method: Over a 4 month period, we retrospectively retrieved dose history data in 25 clinic patients aged 10–18 (mean 15) years, who freely chose the Easypod r-HGH delivery method (for a variety of treatment indications). We audited rates of successful injection delivery, reasons for missed injections and contact with the patient’s SENSE home support nurse.

Results: Average days recorded 117.8 (range 27–184).

Summary: Missed doses were the norm, only a 12% minority being fully adherent even over a short 4 month period. About half missed 10% of doses, but the majority (55%) missed more and a substantial minority (25%) received <60% of their recommended prescription. Adherence deteriorated after the first treatment year and continued to decline to 5 years with no apparent improvement with the SENSE nurse (data not shown).

Conclusion: This small study demonstrates the benefits of inbuilt administration recorders in r-HGH injection devices in assessing growth responses in children. The surprisingly high prevalence of non-adherence, especially after 4 years, is relevant to the cost benefit implications of continued treatment and highlights the importance of addressing patients’ (not parents’ or physicians’) perception of treatment benefit. Switching for a period to the Easypod may allow clinicians to make considered decisions about treatment continuation (and may improve compliance due to the Hawthorn effect).