title: Adherence to growth hormone therapy: results of a multicenter study.
abstract: OBJECTIVE
  To evaluate the adherence to growth hormone (GH) therapy and identify the influencing factors and outcomes in children.
  
  
  METHODS
  A total of 217 GH-naïve patients in 6 pediatric endocrinology clinics were enrolled in the study. Structured questionnaires were filled out and patients were evaluated at the initiation and 3rd, 6th, and 12th months of therapy. Patients were categorized into 4 adherence segments based on percentage of doses omitted at each evaluation period, classified as excellent if 0%, good if 5%, fair if 5 to 10%, and poor if > 10%.
  
  
  RESULTS
  There was a decrement in adherence to GH therapy during the study period (P = .006). Patients who showed excellent and good adherence to therapy had better growth velocity and growth velocity standard deviation scores (SDSs) (P = .014 and P = .015, respectively). A negative correlation between growth velocity SDS and number of missed injections was also observed (r = -.412; P = .007). A positive correlation between delta insulin-like growth factor-1 (IGF-1) SDS and growth velocity was demonstrated (r = .239; P = .042). IGF-1 levels were significantly higher in patients who showed excellent and good adherence to therapy (P = .01). Adherence was better in boys than in girls (P = .035), but adherence rates were not associated with age, cause of GH treatment, socioeconomic status, person who administered the injections, type of injection device, or GH product.
  
  
  CONCLUSIONS
  Poor adherence to GH therapy was common in our group of patients and was one of the factors underlying suboptimal growth during therapy. Before considering other problems that can affect growth, clinicians should confirm good adherence to therapy.
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Banu Küçükemre
authors.initials: BK
authors.lastname: Aydın
authors.affiliation: Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic Department of Pediatric Endocrinology, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Aycan
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Sıklar
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Merih
authors.initials: M
authors.lastname: Berberoğlu
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Gönül
authors.initials: G
authors.lastname: Ocal
authors.affiliation: Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic.
authors.forename: Semra
authors.initials: S
authors.lastname: Cetinkaya
authors.affiliation: Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic.
authors.forename: Veysel Nijat
authors.initials: VN
authors.lastname: Baş
authors.affiliation: Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Pediatric Endocrinology Clinic.
authors.forename: Havva Nur Peltek
authors.initials: HN
authors.lastname: Kendirci
authors.affiliation: Department of Pediatric Endocrinology, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey Endomer Pediatric Endocrinology Center, Ankara, Turkey.
authors.forename: Ergun
authors.initials: E
authors.lastname: Cetinkaya
authors.affiliation: Department of Pediatric Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: Sükran
authors.initials: S
authors.lastname: Darcan
authors.affiliation: Department of Pediatric Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: Damla
authors.initials: D
authors.lastname: Gökşen
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey Department of Pediatrics, Pediatric Endocrinology Unit, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey.
authors.forename: Olcay
authors.initials: O
authors.lastname: Evliyaoğlu
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Mine
authors.initials: M
authors.lastname: Sükür
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Firdevs
authors.initials: F
authors.lastname: Baş
authors.affiliation: Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Feyza
authors.initials: F
authors.lastname: Darendeliler
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006128:Growth / Q000187:drug effects; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D055118:Medication Adherence
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I