Persistence with growth hormone therapy in pediatric patients

Objectives: Height outcomes were assessed in children with idiopathic growth hormone deficiency (IGHD) and multiple pituitary hormone deficiency (MPHD) who discontinued growth hormone (GH) therapy. Study Design: Data were obtained from the American Norditropin Studies: Web-Enabled Research (ANSWER) Program/NovoNet for enrolled children who had discontinued therapy. Methods: Treatment duration (months), height velocity, and corrected height standard deviation score (HSDS) at last clinic visit were evaluated; GH persistence rates were based on diagnosis (IGHD or MPHD) and discontinuation category. Results: Patients who had achieved final height were on GH longer (46 ± 21 months, n = 288) than those who discontinued due to patient/caregiver decision (35 ± 15 months, n = 134), insurance issues (32 ± 21 months, n = 231), and other reasons (31 ± 18 months, n = 173). HSDS and corrected HSDS increased from baseline to year 3 across all categories (P lt;.0001). At year 3, patients in the final-height-achieved category had greater corrected HSDS (-0.3 ± 0.90, n = 179) than those who discontinued because of insurance issues (-0.6 ± 0.81, n = 63; P =.027) and other reasons (-1.0 ± 1.03, n = 55; P =.0006), and had the highest percentage of individuals reaching an HSDS of -2 or greater (96.4%, n = 190). Individuals in the final-height-achieved category were most persistent with GH therapy (P lt;.001). Conclusions: Patients who discontinued GH due to final height achieved had the highest persistence. Consistent insurance standards for GH therapy could improve persistence.