title: Variability in adherence to rhGH treatment: Socioeconomic causes and effect on children's growth.
abstract: BACKGROUND
  In children with growth disorders, mean final height is associated to poor adherence to Growth Hormone therapy. The primary goal of this study is to identify patients who do not adhere to GH therapy and determine the influence of adherence in response to the treatment. The role of serum IGF-I and influence of socio-economic factors on the therapeutic adherence will also be evaluated.
  
  
  METHODS
  158 children under treatment with rhGH were included in the study. Age, gender, etiology, Tanner stage, duration of treatment, growth rate, IGF-I serum values, daily dose, and annual rhGH dose data were collected. Adherence to therapy was defined as moderate-to-poor when the patient had taken less than 92% of the prescribed medication. A subgroup of 106 patients completed a questionnaire to assess social and environmental effects.
  
  
  RESULTS
  Moderate-to-poor adherence to rhGH treatment was determined in 33.5% of study patients. A decrease in adherence was associated to treatment duration (p=0.001). A significant correlation was determined between adherence and height velocity (p=0.002) and IGF-I (p<0.0001) levels. Adherence rates were associated to the mother's educational level (p=0.007).
  
  
  CONCLUSIONS
  Poor adherence to GH therapy was observed in one-third of study patients, resulting in suboptimal growth. IGF-I levels can be helpful to identify patients with poor adherence to GH medication. Physicians should pay special attention to certain characteristics of the patient and their environment, and encourage desirable therapeutic compliance.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain. Electronic address: sldepedro@gmail.com.
authors.forename: Silvina
authors.initials: S
authors.lastname: De Pedro
authors.affiliation: Department of Pediatric Endocrinology, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Murillo
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Salinas
authors.affiliation: Clinical Biochemistry, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: Maria-Luisa
authors.initials: ML
authors.lastname: Granada
authors.affiliation: Department of Pediatric Endocrinology, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Puig-Domingo
authors.affiliation: Pharmaceutics Department, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: Angels
authors.initials: A
authors.lastname: Andreu
authors.affiliation: Department of Pediatric Endocrinology, Hospital Universitari "Germans Trias i Pujol" Badalona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Bel
mesh_terms: D000293:Adolescent; D002648:Child; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone
keywords: Adherence; Socioeconomic factors; rhGH therapy