title: Non-compliance with growth hormone treatment in children is common and impairs linear growth.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand. w.cutfield@auckland.ac.nz
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Cutfield
authors.forename: José G B
authors.initials: JG
authors.lastname: Derraik
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Gunn
authors.forename: Kyle
authors.initials: K
authors.lastname: Reid
authors.forename: Theresa
authors.initials: T
authors.lastname: Delany
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hofman
mesh_terms: D002648:Child; D003625:Data Collection; D006128:Growth / Q000187:drug effects*; D006130:Growth Disorders / Q000188:drug therapy; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D009520:New Zealand; D010349:Patient Compliance / Q000208:ethnology
chemical_list: D019382:Human Growth Hormone