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Association of Daily Growth Hormone Injection Adherence and Height Among Children With Growth Hormone Deficiency

Authors:	Jane Loftus Bradley S Miller Craig S Parzynski Jose Alvir Yong Chen Priti Jhingran Anu Gupta Mitch DeKoven Victoria Divino Jenny Tse Jing He Michael Wajnrajch

Institution:	1. Pfizer Limited, Tadworth, Surrey, United Kingdom;2. University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota;3. Genesis Research, Hoboken, New Jersey;4. Pfizer Inc., New York, New York;5. Pfizer Inc., Collegeville, Pennsylvania;6. IQVIA, Falls Church, Virginia;7. New York University Langone Medical Center, New York, New York

Abstract:	ObjectiveRecombinant human growth hormone (somatropin) is recommended for children with growth hormone deficiency (GHD) to normalize adult height. Prior research has indicated an association between adherence to somatropin and height velocity. Further research is needed using real-world data to quantify this relationship; hence the objective of this study was to investigate the association between adherence to somatropin and change in height among children with GHD.MethodsThis retrospective cohort study included patients in the IQVIA PharMetrics Plus and Ambulatory Electronic Medical Records databases aged 3 to 15 years, with ≥1 GHD diagnosis code claim and newly initiated on somatropin between January 1, 2007 and November 30, 2019. Adherence was measured over the follow-up using the medication possession ratio (MPR); patients were classified as adherent (MPR ≥ 0.8) or nonadherent (MPR < 0.8).ResultsAmong 201 patients initiated on somatropin, 74.6% were male, mean age was 11.4 years, and the mean follow-up was 343.3 days. Approximately 76.6% of patients were adherent to somatropin over the follow-up period. Adjusted growth trajectories were similar between adherent and nonadherent patients pre-treatment initiation (P = .15). Growth trajectories post-initiation were significantly different (P = .001). On average, adherent patients gained an additional 1.8 cm over 1 year compared with nonadherent patients, adjusted for covariates.ConclusionGreater adherence to somatropin therapy is associated with improved height velocity. As suboptimal adherence to daily somatropin therapy is an issue for children with GHD, novel strategies to improve adherence may improve growth outcomes.

Keywords:	pediatric growth hormone deficiency somatropin adherence growth height ADHD"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"attention-deficit/hyperactivity disorder AEMR"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"Ambulatory Electronic Medical Records BMI"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"body mass index GH"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"growth hormone GHD"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"growth hormone deficiency ICD-9 CM"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"International Classification of Diseases Ninth Revision Clinical Modification ICD-10 CM"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"International Classification of Diseases Tenth Revision Clinical Modification MMRM"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"mixed model for repeated measures MPR"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"medication possession ratio QoL"} {"#name":"keyword" "$":{"id":"kwrd0130"} "$$":[{"#name":"text" "_":"quality of life RWD"} {"#name":"keyword" "$":{"id":"kwrd0140"} "$$":[{"#name":"text" "_":"real-world data SD"} {"#name":"keyword" "$":{"id":"kwrd0150"} "$$":[{"#name":"text" "_":"standard deviation SDS"} {"#name":"keyword" "$":{"id":"kwrd0160"} "$$":[{"#name":"text" "_":"standard deviation score
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