Spoudeas Helen A, Bajaj Priti, Sommerford Nathan
London Centre for Paediatric Endocrinology, University College London, London, UK.
Ferring Pharmaceuticals, London, UK.
Patient Prefer Adherence. 2014 Sep 17;8:1255-63. doi: 10.2147/PPA.S70019. eCollection 2014.
Persistence and adherence with subcutaneous growth hormone (GH; somatropin) therapy in children is widely acknowledged to be suboptimal. This study aimed to investigate how the use of a jet-delivery device, ZomaJet(®), impacts on medication-taking behaviors compared to needle-based devices.
A retrospective cohort study of children aged ≤18 years was conducted using a UK-based, nationwide database of GH home-delivery schedules. Data were evaluated for the period between January 2010 and December 2012 for 6,061 children receiving either Zomacton(®) (somatropin) via the ZomaJet jet-delivery device or one of six brands of GH all administered via needle-based devices. Persistence was analyzed for patients with appropriate data, measured as the time interval between first and last home deliveries. An analysis of adherence was conducted only for patients using ZomaJet who had appropriate data, measured by proportion of days covered. Brand switches were identified for all patients.
Persistence with GH therapy was significantly longer in patients using ZomaJet compared to needle-based devices (599 days versus 535 days, respectively, n=4,093; P<0.001); this association was observed in both sexes and across age subgroups (≤10 and 11-16 years). The majority (58%) of patients using ZomaJet were classed as adherent (n=728). Only 297 patients (5%) switched GH brand (n=6,061), and patients tended to use ZomaJet for longer than other devices before switching.
It appears important that the choice of a jet-delivery device is offered to children prescribed daily GH therapy. These devices may represent a much-needed effective strategy for maintaining persistence with subcutaneous GH administration in children, potentially offering better clinical outcomes and greater cost-efficiency.
儿童皮下生长激素（GH；生长激素）治疗的持续性和依从性普遍被认为不理想。本研究旨在调查与基于针头的装置相比，喷射给药装置ZomaJet（®）的使用如何影响用药行为。
使用英国全国性的GH家庭给药时间表数据库，对18岁及以下儿童进行回顾性队列研究。评估了2010年1月至2012年12月期间6061名儿童的数据，这些儿童通过ZomaJet喷射给药装置接受Zomacton（®）（生长激素）治疗，或通过基于针头的装置接受六种GH品牌之一的治疗。对有适当数据的患者进行持续性分析，以首次和最后一次家庭给药之间的时间间隔衡量。仅对使用ZomaJet且有适当数据的患者进行依从性分析，以覆盖天数的比例衡量。确定了所有患者的品牌转换情况。
与基于针头的装置相比，使用ZomaJet的患者GH治疗持续性显著更长（分别为599天和535天，n = 4093；P < 0.001）；在男女及各年龄亚组（≤10岁和11 - 16岁）中均观察到这种关联。使用ZomaJet的患者中大多数（58%）被归类为依从（n = 728）。只有297名患者（5%）转换了GH品牌（n = 6061），且患者在转换前使用ZomaJet的时间往往比其他装置更长。
对于接受每日GH治疗的儿童，提供喷射给药装置的选择似乎很重要。这些装置可能是维持儿童皮下GH给药持续性的急需有效策略，有可能带来更好的临床结果和更高的成本效益。
