Yearly Height Gain Is Dependent on the Truly Received Dose of Growth Hormone and the Duration of Periods of Poor Adherence: Practical Lessons From the French Easypod™ Connect Multicenter Observational Study.
Régis Coutant, Marc Nicolino, Benoit Cammas, Valérie de Buyst, Maïthé Tauber, Jean-François Hamel
Author Information
Régis Coutant: Pediatric Endocrinology and Diabetology Department, Angers University Medical Center, Angers, France.
Marc Nicolino: Pediatric Endocrinology, Diabetology and Metabolism Department, Lyon Women's and Children's Hospital, Lyon, France.
Benoit Cammas: Pediatric Endocrinology Department, Bordeaux Nord Aquitaine Clinic, Bordeaux, France.
Valérie de Buyst: Medical Affairs Department, Merck Serono SAS, an Affiliate of Merck KGaA, Lyon, France.
Maïthé Tauber: Endocrine, Obesity Bone Diseases Gynecology and Genetics Unit, Children's Hospital, Toulouse University Medical Center, Toulouse, France, and Toulouse Institute for Infectious and Inflammatory Diseases, INSERM UMR1291 - CNRS UMR5051, Toulouse III University, Toulouse, France.
Jean-François Hamel: Biostatistics and Methodology Department, Angers University Medical Center, Angers, France, and ESTER Group, IRSET INSERM UMR 1085, Angers University, Angers, France.
Objective: To study the impact of the true mean daily dose and the true mean number of injections per week on the yearly height gain in short children treated with recombinant human growth hormone (rhGH). Design and Methods: 220 children from the French Easypod™ Connect Observational Study (ECOS) used the Easypod™ electronic device to record rhGH injections. The mean daily rhGH dose (the sum of the doses truly received divided by the number of days) and mean number of injections per week (the number of injections truly performed divided by the number of weeks) were calculated. Linear mixed models were used to study the impact of short (3-month) and long (1-year) variations in rhGH administration on the yearly height change [as a standard deviation score (SDS)], with time on treatment as a covariate. For each patient, several periods of 3 or 12 months were considered and designated as poorly adherence or fully adherence. We studied the impact of each of period on the height change. Results: At treatment initiation, the mean ± SD age was 9.8 ± 3.7 years (females: 47%, prepubertal: 86%) and the mean height was -2.28 ± 0.92 SDS. The mean treatment duration was 3.2 ± 1.1 years (685.2 patient years). 122 patients were GH-deficient, 79 were small for gestational age, and 19 had Turner syndrome. When treatment was computed over 12-month periods, receiving a mean daily dose <0.03 mg/kg.d was associated with a 20% lower mean yearly height gain SDS when<3 injections/week were received (vs.>5 injections/week), whereas maintaining a mean daily dose >0.03 mg/kg.d with<3 injections/week was not associated with a lower yearly height gain SDS (vs.>5 injections/week). For 3-month periods, changes in the daily rhGH dose or the number of injections per week over such short period did not influence the yearly height gain SDS. Conclusion: The 12-month treatment model showed that when poor adherence leads to a low true daily GH dose, the yearly height gain is low. The 3-month treatment model showed that poor adherence for short periods (<3 months) had no impact on the height SDS.
