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Interventions Designed to Improve Adherence to Growth Hormone Treatment for Pediatric Patients and Their Families: A Narrative Review. Pharmaceutics 2022; 14:pharmaceutics14112373. [DOI: 10.3390/pharmaceutics14112373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Even though growth hormone (GH) treatment is still the only active treatment option to correct growth failure and increase stature for patients with GH deficiencies, evidence has shown that non-adherence remains high. The aim of this review was to identify and review the existing interventional strategies that have been designed to address and improve adherence to GH treatment for pediatric patients and their families. An extensive search of several electronic databases was undertaken to identify relevant interventional studies, published in English, between 1985 and 2021. Additional search strategies included hand-searching topic review articles to identify eligible studies. Articles were screened against the inclusion eligibility criteria and data on sample characteristics, intervention features, and key findings was extracted. A total of fifteen interventional studies were included in the review. The interventions identified were divided into two broad categories: novel injection devices, and patient choice of device. In conclusions, this review acknowledges that there is a lack of evidence-based, theory-driven intervention strategies, designed with the purpose of optimizing treatment adherence and improve clinical and psychosocial outcomes.
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Su PH, Yang C, Chao MC, Chiang CL. Monitoring Adherence Rate to Growth Hormone Therapy and Growth Outcomes in Taiwanese Children Using Easypod Connect: Observational Study. JMIR Pediatr Parent 2021; 4:e14774. [PMID: 33448936 PMCID: PMC7846437 DOI: 10.2196/14774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/23/2020] [Accepted: 11/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adherence to growth hormone therapy is difficult to detect reliably. Devices such as easypod have been developed for electronic recording of injections. The easypod connect observational study (ECOS) was an open-label, observational, multinational, phase IV study conducted in 24 countries around the world. The final results from ECOS in the Taiwanese cohort are reported in this paper. OBJECTIVE This study aimed to evaluate the adherence and long-term outcomes of growth hormone therapy in pediatric subjects using the easypod electromechanical device. METHODS Subjects (aged 2-18 years or >18 years without fusion of growth plates) who received Saizen (recombinant human growth hormone, somatropin) via the easypod device were enrolled in this study. The primary objective was to assess the level of adherence in subjects receiving Saizen via easypod. RESULTS In Taiwan, a total of 35 and 13 children fulfilled the criteria of full analysis set and complete analysis set, respectively. The mean (SD) age of the complete analysis set was 12.08 (2.72) years. All subjects were growth hormone-naïve, with 38% (5/13) females. The mean adherence rates of 13 subjects were 87.6% at 3 months and 84.3% at 6 months, that of 8 subjects was 81.0% at 9 months, and that of 4 subjects was 91.6% at 1 year. After 1 year of treatment, subjects had a median (Q1:Q3) change in height SD score of 0.30 (0.06:0.48), median height velocity of 6.50 (4.33:8.24) cm/year, and median change in height velocity SD score of 1.81 (-0.04:3.52). CONCLUSIONS With the easypod device, patients with inadequate adherence and poor response to treatment can be identified. Adherence to growth hormone therapy administered via easypod was generally high in the first year of treatment but the adherence gradually decreased over time. Overall, growth outcomes after 1 year indicated a positive growth response to growth hormone treatment. Future efforts should be focused on personalized management of adherence by using the easypod system.
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Affiliation(s)
- Pen-Hua Su
- School of Medicine, Chung-Shan Medical University, Taichung City, Taiwan.,Department of Pediatrics and Genetics, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Chen Yang
- Division of Genetics, Metabolism and Endocrinology, Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Mei-Chyn Chao
- Department of Pediatric Genetics, Changhua Christian Children's Hospital, Changhua, Taiwan.,Department of Pediatric Genetics, Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Yuen KCJ, Llahana S, Miller BS. Adult growth hormone deficiency: clinical advances and approaches to improve adherence. Expert Rev Endocrinol Metab 2019; 14:419-436. [PMID: 31721610 DOI: 10.1080/17446651.2019.1689119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022]
Abstract
Introduction: There have been significant clinical advances in the understanding of the diagnosis and benefits of long-term recombinant human growth hormone (rhGH) replacement in adults with GH deficiency (GHD) since its approval in 1996 by the United States Food and Drug Administration.Areas covered: We searched PubMed, Medline, CINAHL, EMBASE and PsychInfo databases between January 2000 and June 2019 for published studies evaluating adults with GHD. We reviewed the data of the oral macimorelin test compared to the GHRH plus arginine and the insulin tolerance tests that led to its approval by the United States FDA and European Medicines Agency for adult diagnostic testing. We summarize the clinical advances of long-term benefits of rhGH therapy and the potential effects of GH receptor polymorphisms on individual treatment responsiveness. We identify that non-adherence and discontinuation rates are high and recommend strategies to support patients to improve adherence. We also provide an overview of several long-acting GH (LAGH) preparations currently under development and their potential role in improving treatment adherence.Expert opinion: This article summarizes recent clinical advances in rhGH replacement therapy, the biological and molecular aspects that may influence rhGH action, and offers practical strategies to enhance adherence in adults with GHD.
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Affiliation(s)
- Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
| | - Sofia Llahana
- Division of Nursing, School of Health Sciences, City University of London, London, UK
| | - Bradley S Miller
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Franzese C, Thomas C, Rinaldi A, Constable K, Nakamura K, Kalbermatten A, Coyne M. The burden of at-home preparation of lyophilized parenteral medications: an analysis of contributing factors and implications for chronic disease patients and caregivers. Expert Opin Drug Deliv 2019; 16:187-198. [PMID: 30636541 DOI: 10.1080/17425247.2019.1569626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the acute care setting, parenteral medication errors are well-studied. However, there is comparatively little research on how these issues translate to patient- or caregiver-prepared medications in the home, particularly with reconstituted medications. METHODS This was an ethnographic study designed to identify issues associated with four reconstitution use scenarios. Preparation burden was determined by measuring the time and manipulations required to prepare reconstituted medications across three preparation phases (assembly, reconstitution, and transfer). Deviations from product instructions for use, sterility breaches, self-reported preparation complications, and supply storage conditions were also analyzed. RESULTS A total of 14 participants completed the study. Overall, preparation burden was markedly higher when purpose-built reconstitution devices were not available. The majority of participants reported experiencing at least one complication associated with their medication preparation process; the reconstitution phase was the most significant source of both instructions for use deviations and breaches in sterility. Participants reported that the volume and variety of medication preparation supplies were a significant source of burden. CONCLUSIONS At-home preparation of reconstituted medications poses several challenges for patients and caregivers. As parenteral medications continue to shift towards self-administration, manufacturers should carefully consider the usability of such products and employ purpose-built reconstitution devices whenever possible.
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Affiliation(s)
| | | | | | | | - Koji Nakamura
- b Terumo Pharmaceutical Solutions , Somerset , NJ , USA
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Mohseni S, Heydari Z, Qorbani M, Radfar M. Adherence to growth hormone therapy in children and its potential barriers. J Pediatr Endocrinol Metab 2018; 31:13-20. [PMID: 29216008 DOI: 10.1515/jpem-2017-0157] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/01/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the main concerns in chronic diseases such as growth hormone (GH) deficiency is adherence to the treatment, which significantly affects treatment outcomes. METHODS This cross-sectional study was conducted among 169 GH recipient children (2-12 years) and teens (13-19 years) referred to a GH distributing teaching pharmacy. The eight-item Morisky Medication Adherence Scale (MMAS) and auto-compliance method were used for the assessment of patients' adherence to GH. The potential barriers to GH therapy adherence and medication persistence were also explored. RESULTS Based on the MMAS method, 56.7% of the children and 57.9% of the adolescent groups were adherent to GH therapy. Conversely, according to the auto-compliance method almost all the patients were adherent in the children (95.2%) and adolescent (95.5%) groups. Forgetting to take the injection or refill the prescription, being away from home, exhaustion from long-term injection, drug shortage and inaccessibility to the pharmacy were barriers found to be significantly associated with a low adherence in the children group. While in the adolescent group, forgetting to take the injection, painful injection, concern about long-term complications and exhaustion from long-term injection revealed a significant association with low adherence. Persistence with GH therapy was reported in 75.3% and 67% of children and adolescent patients, respectively. CONCLUSIONS The current study revealed that overall adherence of the study population is low. Considering the barriers with significant association with adherence, different strategies can be incorporated to enhance adherence to GH therapy, i.e. providing early patient and parent education and support, medication reminder systems and longer duration of GH prescriptions.
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Affiliation(s)
- Shahrzad Mohseni
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Heydari
- Faculty of Pharmacy, Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mania Radfar
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Faculty of Pharmacy, Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Marcianò I, Ingrasciotta Y, Giorgianni F, Ientile V, Chinellato A, Tari DU, Gini R, Cannavò S, Pastorello M, Scondotto S, Cananzi P, Traversa G, Trotta F, Belleudi V, Addis A, Trifirò G. Pattern of Use of Biosimilar and Originator Somatropin in Italy: A Population-Based Multiple Databases Study During the Years 2009-2014. Front Endocrinol (Lausanne) 2018; 9:95. [PMID: 29593655 PMCID: PMC5859012 DOI: 10.3389/fendo.2018.00095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/27/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Somatropin [recombinant growth hormone (rGH)] is approved in children and adults for several conditions involving growth disturbances and the corresponding biosimilar is available in Italy since 2006. No population-based data are available on the pattern of rGH use in Italian clinical practice. This study aimed at exploring the pattern of biosimilar and originator rGH use in six Italian centers, where different policy interventions promoted biosimilar use. METHODS This population-based, drug-utilization study was conducted in the years 2009-2014, using administrative databases of Umbria, Tuscany, and Lazio Regions and Local Health Units of Caserta, Treviso, and Palermo. Naïve rGH users were characterized, and prevalence of use and discontinuation were assessed over time. RESULTS Among 6,785 patients treated with rGH during the study years, 4,493 (66.2%) were naïve users (males/females = 1.3), mostly affected by GH deficiency. The prevalence of rGH use increased from 2009 to 2010, remaining stable thereafter, but it was heterogeneous across centers (twofold higher prevalence of use in center n.2 than centers n.4 and 1 in 2014). Biosimilar rGH uptake increased over time but was low (7.8% in 2014) and heterogeneous as well. Discontinuation of rGH therapy occurred in 54.0% of naïve users, more frequently in females than males (58.1 vs. 50.9%). During the first year of treatment, discontinuation was frequent (39.9%), but no statistically significant differences were observed in treatment persistence for biosimilar vs. originator rGH (p > 0.05). CONCLUSION Geographical heterogeneity in the prevalence of rGH use was observed. Similarly, the biosimilar rGH uptake was low and variable across centers. Post-marketing monitoring is required to continuously monitor the benefit-risk profile of rGH, thus guaranteeing greater savings than only promoting lowest cost rGH.
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Affiliation(s)
- Ilaria Marcianò
- Unit of Clinical Pharmacology, A.O.U. Policlinico “G. Martino”, Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | | | - Valentina Ientile
- Unit of Clinical Pharmacology, A.O.U. Policlinico “G. Martino”, Messina, Italy
| | | | | | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Salvatore Cannavò
- Endocrinology, Department of Adult and Childhood Human Pathology G. Barresi, University of Messina, Messina, Italy
| | | | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Pasquale Cananzi
- Sicilian Regional Centre of Pharmacovigilance, Servizio 7-Farmaceutica, Health Department of Sicily, Palermo, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Francesco Trotta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Gianluca Trifirò
- Unit of Clinical Pharmacology, A.O.U. Policlinico “G. Martino”, Messina, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, Netherlands
- *Correspondence: Gianluca Trifirò,
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Acerini CL, Segal D, Criseno S, Takasawa K, Nedjatian N, Röhrich S, Maghnie M. Shared Decision-Making in Growth Hormone Therapy-Implications for Patient Care. Front Endocrinol (Lausanne) 2018; 9:688. [PMID: 30524377 PMCID: PMC6262035 DOI: 10.3389/fendo.2018.00688] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022] Open
Abstract
Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT. Improved adherence to therapy in this way may consequently positively impact treatment outcomes for patients. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM, and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.
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Affiliation(s)
- Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Carlo L. Acerini
| | - David Segal
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherwin Criseno
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kei Takasawa
- Department of Paediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Mohamad Maghnie
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
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Coutant R, Dupuis C, Pigeon P, Rebaud P. Patients' perceptions on the usability of the SurePal™ self-injection device for Omnitrope ®: a questionnaire-based observational study conducted in paediatric patients in France. Ther Adv Endocrinol Metab 2017; 8:129-137. [PMID: 29051812 PMCID: PMC5638162 DOI: 10.1177/2042018817730545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A questionnaire-based survey was conducted to evaluate attitudes towards a reusable self-injection system, SurePal™, among paediatric patients with growth disturbances who were prescribed treatment with somatropin (Omnitrope®) as part of routine clinical practice. METHODS This cross-sectional survey was incorporated into the multinational, multi-centre, noninterventional PAtients TReated with Omnitrope® (PATRO) Children study. Questions were mainly focused on five areas: the attractiveness of SurePal™; training received; use of the device; opinion of the low-drug wastage system; experience compared with previous devices used (among pretreated patients). RESULTS Final results from participants in France are reported. Completed questionnaires were returned by 409 participants. Most patients (55%) were male and 89% were recombinant human growth hormone (rhGH)-treatment naïve. Around 57% of children completed the questionnaire by themselves, while 43% had help from a family member/other person. The mean (standard deviation) age of all participants was 11.3 (3.6) years, and most patients were aged 10-12 years (n = 126) or 13-15 years (n = 117). Overall, 86% of patients reported that preparing SurePal™ for injection was easy/very easy. Similarly, 83% reported that performing injections with SurePal™ was easy/very easy. The attractiveness of SurePal™ was rated as good/excellent by the majority (85%) of patients; this proportion was similarly high (> 80%) across all age groups. The dose-memory function was rated as helpful/very helpful by 54% of patients. Of the 174 patients who reported using the low drug-waste feature, 90% found it to be helpful/very helpful. Among the 24 pretreated patients, 17 reported that SurePal™ was better/much better than their previous device. CONCLUSIONS This questionnaire-based survey conducted in a large cohort of paediatric patients with growth disturbances from France confirms the ease of use of SurePal™ to support daily administration of Omnitrope® across all age groups. The demonstrated acceptability of the device may help to improve patient adherence to long-term daily treatment with rhGH.
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Affiliation(s)
| | - Clémentine Dupuis
- Service d’Endocrinologie Pediatrique, CHU Grenoble, Grenoble, France
| | | | - Phillipe Rebaud
- Service de Pediatrie, Centre Hospitalier Villefranche, Gleize, France
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Chapman SR, Fitzpatrick RW, Aladul MI. What drives the prescribing of growth hormone preparations in England? Prices versus patient preferences. BMJ Open 2017; 7:e013730. [PMID: 28400458 PMCID: PMC5541334 DOI: 10.1136/bmjopen-2016-013730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The patent expiry of a number of biological medicines and the advent of biosimilars raised the expectations of healthcare commissioners that biosimilars would reduce the high cost of these medicines and produce potential savings to the NHS. We aimed to examine the prescribing pattern of different growth hormone preparations (ready to use and reconstitution requiring) in primary and secondary care in England to determine relative rates of decrease or increase and identify the possible factors influencing prescribing following the introduction of biosimilar growth hormone in 2008. DESIGN Longitudinal observational study. SETTING AND DATA SOURCES Primary care prescribing cost and volume data was derived from the NHS business services authority website, and for secondary care from the DEFINE database, between April 2011 and December 2015. OUTCOMES Quarterly prescribing analysis to examine trends and measure the relationship between usage and price. RESULTS Expenditure and usage of growth hormone in primary care decreased by 17.91% and 7.29%, respectively, whereas expenditure and usage in secondary care increased by 68.41% and 100%, respectively, between April 2011 and December 2015. The usage of reconstitution requiring products significantly declined in primary care (R²=0.9292) and slightly increased in use in secondary care (R²=0.139). In contrast, the usage of ready-to-use products significantly increased in use in primary (R²=0.7526) and secondary care (R²=0.9633), respectively. Weak or no correlation existed between the usage and price of growth hormone preparations in primary and secondary care. CONCLUSIONS The price of growth hormone products was not the key factor influencing the prescribing of the biological medicines. The main driver for specific product selection was the ease of use and the number of steps in dose preparation. Prescribers appear to be taking into account patient preferences rather than cost in their prescribing decisions.
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Affiliation(s)
- Stephen R Chapman
- School of Pharmacy, Keele University, Newcastle-under-Lyme, Staffordshire, UK
| | | | - Mohammed I Aladul
- School of Pharmacy, Keele University, Newcastle-under-Lyme, Staffordshire, UK
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Ridyard CH, Dawoud DMM, Tuersley LV, Hughes DA. A Systematic Review of Patients' Perspectives on the Subcutaneous Route of Medication Administration. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:281-92. [PMID: 26792584 DOI: 10.1007/s40271-015-0160-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Subcutaneous injections allow for self-administration, but consideration of patients' perspectives on treatment choice is important to ensure adherence. Previous systematic reviews have been limited in their scope for assessing preferences in relation to other routes of administration. OBJECTIVE Our objective was to examine patients' perspectives on subcutaneously administered self-injectable medications when compared with other routes or methods of administration for the same medicines. METHODS Nine electronic databases were searched for publications since 2000 using terms pertaining to methods of administration, choice behavior, and adverse effects. Eligibility for inclusion was determined through reference to specific criteria by two independent reviewers. Results were described narratively. RESULTS Of the 1726 papers screened, 85 met the inclusion criteria. Studies were focused mainly on methods of insulin administration for diabetes but also included treatments for pediatric growth disorders, multiple sclerosis, HIV, and migraine. Pen devices and autoinjectors were favored over administration with needle and syringe, particularly with respect to ergonomics, convenience, and portability. Inhalation appeared to be more acceptable than subcutaneous injection (in the case of insulin), but how subcutaneous infusion, intramuscular injection, and needle-free injection devices compare with subcutaneous injections in terms of patient preference is less certain. CONCLUSIONS The review identified a number of studies showing the importance of the methods and routes of drug delivery on patient choice. However, studies were prone to bias, and further robust evidence based on methodologically sound approaches is required to demonstrate how patient choice might translate to improved adherence.
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Affiliation(s)
- Colin H Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, LL57 2PZ, UK
| | | | - Lorna V Tuersley
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, LL57 2PZ, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, LL57 2PZ, UK.
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Rohrer TR, Horikawa R, Kappelgaard AM. Growth hormone delivery devices: current features and potential for enhanced treatment adherence. Expert Opin Drug Deliv 2016; 14:1253-1264. [DOI: 10.1080/17425247.2017.1243526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tilman R. Rohrer
- Department of Pediatrics and Adolescent Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Anne-Marie Kappelgaard
- Clinical, Medical and Regulatory, Novo Nordisk International Operations A/G, Zurich, Switzerland
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Schnabel D, Partsch CJ, Houang M, Ehtisham S, Johnstone H, Zabransky M, Kiess W. Acceptance of a reusable self-injection device for recombinant human growth hormone: final data from a questionnaire-based, cross-sectional, international, multicenter, observational study in pediatric patients. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:317-24. [PMID: 27660496 PMCID: PMC5019470 DOI: 10.2147/mder.s115933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A questionnaire-based survey was conducted to assess attitudes toward a reusable self-injection system (SurePal™) among pediatric patients with growth disturbances who were prescribed treatment with Omnitrope® within routine clinical practice. Methods This was a multicenter, observational study, incorporated into the noninterventional PAtients TReated with Omnitrope® (PATRO) Children study. Included subjects, or their caregivers, completed a questionnaire on the following five main areas: attractiveness of SurePal™, training received, using the device, the low drug wastage system, and experience versus other devices used previously (pretreated patients). Responses were based on a 5-point scale, with 2 being the best possible outcome and −2 the worst possible outcome. Results In total, 550 patients were included in this study (338 from France, 169 from Germany, and 43 from the UK). The mean age ± standard deviation of participants was 10.8±3.5 years; the majority (57%) were male and growth hormone treatment naïve (88%). Almost half (49.8%) of children prepared their SurePal™ for injection themselves and 45.5% performed injections themselves. As patients progressed into their teens, the majority (≥75%) favored preparing SurePal™ and performing injections themselves, rather than seeking assistance. The attractiveness of SurePal™ was rated as excellent/good by 84.7% of patients overall; this rating was similarly high (≥79%) across countries and age-groups. Preparing (88.8%) and using (83.3%) SurePal™ were rated as very easy/easy by most patients; these ratings were similarly high, irrespective of country or age-group. The dose-memory function was rated as very helpful/helpful by 66.2% of patients. Among 246 patients who reported using the low drug-waste feature, 87.4% found it helpful. Among pretreated patients (n=64), 78.2% reported that SurePal™ was much better/better than their previous device. Conclusion These data confirm the ease of use and patient preference for SurePal™ among pediatric patients with growth disturbances.
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Affiliation(s)
- Dirk Schnabel
- Pediatric Endocrinology, Center for Chronic Sick Children, Otto-Heubner-Centrum für Kinder- und Jugendmedizin, Charite, University Medicine, Berlin, Germany
| | | | - Muriel Houang
- Explorations Fonctionnelles Endocriniennes, Hôpital Armand Trousseau, Paris, France
| | - Sarah Ehtisham
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Helen Johnstone
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, Germany
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Marini MG, Chesi P, Mazzanti L, Guazzarotti L, Toni TD, Salerno MC, Officioso A, Parpagnoli M, Angeletti C, Faienza MF, Iezzi ML, Aversa T, Sacchetti C. Stories of experiences of care for growth hormone deficiency: the CRESCERE project. Future Sci OA 2016; 2:FSO82. [PMID: 28031934 PMCID: PMC5137913 DOI: 10.4155/fso.15.82] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/14/2015] [Indexed: 12/02/2022] Open
Abstract
AIMS Growth hormone deficiency therapy is demanding for patients and caregivers. Teams engaged in the clinical management of growth hormone deficiency therapy need to know how families live with this condition, to provide an adequate support and prevent the risk of withdrawal from therapy. METHODS Using Narrative Medicine, testimonies from patients, their parents and providers of care were collected from 11 Italian centers. Narrations were analyzed throughout an elaboration of recurring words and expressions. RESULTS Although care management and outcomes were considered satisfying in the 182 collected narratives, recurring signals of intolerance among adolescents and the worry of not being well informed about side effects among parents are open issues. CONCLUSION Narratives found that communication issues could decrease adherence and influence the physicians' clinical practice.
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Affiliation(s)
- Maria G Marini
- ISTUD Foundation, Health Care & Wellbeing Area, Milan, Italy
| | - Paola Chesi
- ISTUD Foundation, Health Care & Wellbeing Area, Milan, Italy
| | - Laura Mazzanti
- Paediatric Endocrinology Unit, Paediatric Department ‘Sant'Orsola Malpighi’ University Hospital, Bologna, Italy
| | | | | | - Maria C Salerno
- Paediatric Section, Department of Translational Medical Sciences ‘Federico II’, Naples, Italy
| | - Annunziata Officioso
- Paediatric Section, Department of Translational Medical Sciences ‘Federico II’, Naples, Italy
| | | | | | | | - Maria L Iezzi
- Pediatrician Clinic, Hospital District ‘San Salvatore’, L'Aquila, Italy
| | - Tommaso Aversa
- Department of Paediatrics, University of Messina, Messina, Italy
| | - Cinzia Sacchetti
- Italian Association of Families with subjects with a GHD A.Fa.D.O.C., Vicenza, Italy
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14
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Partsch CJ, Schnabel D, Ehtisham S, Johnstone HC, Zabransky M, Kiess W. Acceptability of the reusable SurePal™ self-injection device for Omnitrope(®) among pediatric patients: results from a questionnaire-based, cross-sectional, multicenter observational study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:389-93. [PMID: 26405430 PMCID: PMC4578482 DOI: 10.2147/mder.s93209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background SurePal™ is a reusable self-injection system that has been developed to support daily administration of Omnitrope® (Sandoz, Kundl, Austria). A questionnaire-based cross-sectional survey was conducted to evaluate acceptability of, and preference for, SurePal™ in pediatric patients who were prescribed treatment with Omnitrope® within routine clinical care. Methods This multicenter, observational study was incorporated into the ongoing non-interventional PATRO (PAtients TReated with Omnitrope®) Children study. Patients (or caregivers) were provided with a questionnaire that included five main topics; attractiveness of the device, training received, using SurePal™, the low drug wastage system, and experience versus other devices used previously (where applicable). Questions were scored on a 5-point scale, with −2 being the worst possible outcome (eg, very hard/very poor) and 2 being the best possible outcome (eg, very easy/excellent). Results A total of 186 patients were included in this study (Germany, n=154; UK, n=32). The attractiveness of SurePal™ was rated as excellent/good by 87.1% of patients. Overall, 86.5% of patients found that using their SurePal™ was very easy/easy. Almost all patients (96.2%) found that preparing their SurePal™ for injection was very easy/easy, and 89.2% found that injecting with SurePal™ was very easy/easy. 85.5% of patients recorded that the dose memory function was helpful, and 87.6% that taking their SurePal™ apart after an injection was very easy/easy. Of the 88 patients who recorded that they had used the low drug waste feature, 89.8% found the feature to be helpful. Among pre-treated patients (n=42), 81% recorded that SurePal™ was much better/better than their previously used device. Conclusion This questionnaire-based cross-sectional survey in pediatric patients confirms the ease of use and patient preference for SurePal™, a reusable self-injection system that has been developed to support daily administration of Omnitrope®.
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Affiliation(s)
| | - Dirk Schnabel
- Division of Endocrinology and Diabetology, Otto-Heubner-Center for Pediatric and Adolescent Medicine, Charité University, Berlin, Germany
| | - Sarah Ehtisham
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Helen C Johnstone
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, Germany
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Kappelgaard AM, Metzinger CP, Schnabel D. A web-based survey assessing the impact of storage flexibility on the daily life of patients and caregivers administering growth hormone. Expert Rev Med Devices 2015; 12:517-27. [DOI: 10.1586/17434440.2015.1069180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Dahlgren J. Easypod™ a new electronic injection device for growth hormone. Expert Rev Med Devices 2014; 5:297-304. [DOI: 10.1586/17434440.5.3.297] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Kappelgaard AM, Hansen NÅ. Comparison of injection dose force, accuracy and precision among three growth hormone injection devices. Expert Rev Med Devices 2014; 10:321-7. [DOI: 10.1586/erd.13.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Spoudeas HA, Bajaj P, Sommerford N. Maintaining persistence and adherence with subcutaneous growth-hormone therapy in children: comparing jet-delivery and needle-based devices. Patient Prefer Adherence 2014; 8:1255-63. [PMID: 25258519 PMCID: PMC4172194 DOI: 10.2147/ppa.s70019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Helen A Spoudeas
- London Centre for Paediatric Endocrinology, University College London, London, UK
| | - Priti Bajaj
- Ferring Pharmaceuticals, London, UK
- Correspondence: Priti Bajaj, Ferring Pharmaceuticals, Drayton Hall, Church Road, West Drayton, London UB7 7PS, UK, Tel +44 20 8580 4148, Fax +44 844 931 0058, Email
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19
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Fisher BG, Acerini CL. Understanding the growth hormone therapy adherence paradigm: a systematic review. Horm Res Paediatr 2013; 79:189-96. [PMID: 23635797 DOI: 10.1159/000350251] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/25/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Growth hormone (GH) therapy is used to treat a variety of growth disorders in childhood/adolescence. Its efficacy is thought to be dependent on patients' adherence to their treatment regimen. METHODS PubMed was searched using the keywords 'growth hormone', 'child'[Mesh], 'adolescent'[Mesh], and 'patient compliance'[Mesh]. RESULTS Most studies of adherence to paediatric GH therapy have used either issued/encashed GH prescriptions or questionnaires. Estimates of prevalence of non-adherence vary from 5-82%, depending on the methods and definitions used. Different studies have variously demonstrated an association (or lack thereof) between adherence and age, socioeconomic status, treatment duration, injection device used and injection-giver. A number of interventions have been proposed to improve adherence, including offering a choice of injection device, but none are supported by trials. Poor adherence is associated with reduced height velocity and likely increased economic costs; evidence for other effects is circumstantial. CONCLUSION Adherence to paediatric GH therapy is suboptimal, which may partially explain why the mean final height attained is below that of the general population. Analysis of the causes of non-adherence is complicated by conflicting evidence from different studies. Multifactorial interventions are most likely to be successful in improving adherence. We make recommendations for further research.
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Meinhardt U, Eiholzer U, Seitz L, Bøgelund M, Kappelgaard AM. Parent preference in Switzerland for easy-to-use attributes of growth hormone injection devices quantified by willingness to pay. Expert Rev Med Devices 2013; 11:31-8. [DOI: 10.1586/17434440.2014.856754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Rohrer TR, Winter F, Qvist M, Kappelgaard AM. Comparison of intuitiveness, ease of use and preference among three prefilled, disposable growth hormone injection pens. Expert Opin Drug Deliv 2013; 10:1603-12. [DOI: 10.1517/17425247.2013.829451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Rapaport R, Saenger P, Schmidt H, Hasegawa Y, Colle M, Loche S, Marcantonio S, Bonfig W, Zabransky M, Lifshitz F. Validation and ease of use of a new pen device for self-administration of recombinant human growth hormone: results from a two-center usability study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:141-6. [PMID: 24039458 PMCID: PMC3770891 DOI: 10.2147/mder.s50088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Close adherence to the recommended treatment regimen is important for the success of recombinant human growth hormone therapy, although nonadherence can be common. Ease of use and safety during use/storage are among several important factors in the design of a growth hormone injection device intended for long-term use. This study was performed to validate the usability and assess the ease of use of a new pen device (SurePal™) that has been developed to support daily administration of the recombinant human growth hormone product, Omnitrope® (somatropin). The primary objectives of the study were to assess if study participants, representing intended users of the pen in clinical practice, were able to perform an injection procedure into an injection pad effectively and safely and disassemble the pen without receiving a needlestick injury. A total of 106 participants (61 adults and 45 children/adolescents) were enrolled at two study centers (one in the US, one in Germany). Results for both primary usability tasks met the predefined acceptance criteria, with >85% of participants successfully performing each task. All of the other tasks/handling steps assessed were also successfully performed by most participants, with high success rates reflected in the high proportion of participants who classified each task as “very easy” or “easy”. After a second use of the device, 87%–97% of participants rated it as “very easy” or “easy” to use. In summary, the new pen device is safe and easy to use for both adults and children, and will help to support effective, long-term daily administration of the recombinant human growth hormone product, Omnitrope®.
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Affiliation(s)
- Robert Rapaport
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai School of Medicine, Mineola, NY, USA
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23
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Kremidas D, Wisniewski T, Divino VM, Bala K, Olsen M, Germak J, Aagren M, Holot N, Lee WC. Administration burden associated with recombinant human growth hormone treatment: perspectives of patients and caregivers. J Pediatr Nurs 2013; 28:55-63. [PMID: 22300524 DOI: 10.1016/j.pedn.2011.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/12/2011] [Accepted: 12/31/2011] [Indexed: 11/25/2022]
Abstract
Patients treated with recombinant human growth hormone (rhGH) for growth hormone disorders follow a challenging treatment schedule. This study assessed patient and caregiver experiences with rhGH therapy treatment regimens. Patients 13 years or older with growth hormone deficiency and caregivers completed Web-based surveys. A total of 61 patients and 239 caregivers participated. Storage of rhGH was considered burdensome by more than a third. More than 51% considered storage "somewhat more" to "much more of a burden" relative to the burden while not traveling. "Away from home or traveling" was the most frequently endorsed reason for missing a dose. rhGH treatment while traveling is challenging because of rhGH storage burden.
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24
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Kaptein AA. Transjecting growth hormone: continuous nightmare or controlled nuisance? Evaluation of a new needle-free device. Patient Prefer Adherence 2013; 7:703-8. [PMID: 23926423 PMCID: PMC3728268 DOI: 10.2147/ppa.s46990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Administering growth-hormone therapy (GHT) is a long-term treatment, associated with avoidance and phobic behaviors in the children involved. The current study examined GHT users' perceptions of a new needle-free device (ZomaJet Vision X [10 mg/mL]) with a lower injection volume compared to the traditional device. METHODS A total of 73 persons participated (mean age ± standard deviation, 10.10 ± 3.60 years) in a longitudinal design. Users' views were studied 4 weeks after having applied both the old and the new device for a period of at least 4 weeks. Satisfaction, ease and frequency of restitution, local sensations, bruises during administering GHT, affective response to local sensations, and subject preference were assessed on the basis of the users' responses. RESULTS Subjects' satisfaction with the new device was equal compared with the previous device for the total group of 73 children. However, the subgroup of 59 children who proved tolerant to meta-cresol (new preservative for Vision X only) reported a significantly higher satisfaction rating with the new device compared to the old device (7.7 vs 6.6, P=0.0002). Vision X was evaluated as better on ease and frequency of restitution and the number of bruises. Pain sensations did not differ meaningfully between the two devices. The new device was favored over the previous one in a majority of respondents. Vision X allows easy reconstitution of the solution, which was reflected in the percentage of young children able to prepare transjections themselves being more than doubled, illustrating the greater sense of empowerment in these users. Self-reported adherence to the therapy was good (less than 10% of injections missed) with both devices. CONCLUSION The new device ZomaJet Vision X appears to be evaluated more positively than the previous version on criteria that refect users' preferences.
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Affiliation(s)
- Ad A Kaptein
- Medical Psychology Section, Leiden University Medical Centre, Leiden, Netherlands
- Correspondence: Ad A Kaptein, Medical Psychology Section, Leiden University Medical Centre (LUMC), PO Box 9600, Leiden 2300 RC, Netherlands Tel + 31 71 526 2905 Fax +31 71 524 8123 Email
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25
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Acerini C, Albanese A, Casey A, Denvir L, Jones J, Mathew V, Musson P, Sparrow S. Initiating growth hormone therapy for children and adolescents. ACTA ACUST UNITED AC 2012; 21:1091-7. [PMID: 23123840 DOI: 10.12968/bjon.2012.21.18.1091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is common for children and adolescents on growth hormone (GH) treatment to miss one or more injections per week, thereby compromising their linear growth outcome. Among factors likely to affect treatment concordance are patient education and support in the selection of the most appropriate GH injection device. The authors discovered inconsistencies in the process of starting patients on GH therapy throughout the UK, and found that there were no clinical recommendations to support health professionals starting patients on treatment. This article describes the issues involved and the development of practical recommendations for use when starting paediatric patients on long-term GH therapy.
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26
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Rubin RR, Peyrot M, Metzinger CP, Xu Y, Lippe B, McCormack L, Davis DA. An observational study to validate the Satisfaction Measure of the Injection of Growth Hormone Therapy (SMIGHTy) questionnaire. Curr Med Res Opin 2011; 27:2009-17. [PMID: 21919819 DOI: 10.1185/03007995.2011.613922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to psychometrically evaluate a tool to measure adult caregivers' level of satisfaction with the delivery device used to administer injections of recombinant human growth hormone (rhGH) to a child - the Satisfaction Measure of the Injection of Growth Hormone Therapy (SMIGHTy*) questionnaire. RESEARCH DESIGN AND METHODS One hundred caregivers who administer rhGH to a child using an injection device completed the SMIGHTy questionnaire at baseline and 7-14 days later, and also completed other measures of treatment adherence and treatment satisfaction at baseline. MAIN OUTCOME MEASURES SMIGHTy reliability (inter-item and test-retest) and external validity (association with other study measures) were assessed. RESULTS Analyses revealed good inter-item agreement and test-retest reliability for the SMIGHTy questionnaire. External validity, measured by associations with adherence and other measures of treatment satisfaction, was high. STUDY LIMITATIONS This study assessed only adult caregivers; the instrument was not validated for use by young or adult patients. CONCLUSIONS The SMIGHTy instrument is more comprehensive than existing instruments for assessing the growth hormone treatment experience. It is multidimensional, assesses both positive and negative aspects of the treatment experience (Device Satisfaction, Negative Events, Benefits), and has separate measures of overall satisfaction and preference.
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Affiliation(s)
- Richard R Rubin
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Hokken-Koelega A, Keller A, Rakov V, Kipper S, Dahlgren J. Patient Acceptance, Ease of Use, and Preference for Norditropin NordiFlex with NordiFlex PenMate: Results from an Open-Label, User Survey of Everyday Use. ISRN ENDOCRINOLOGY 2011; 2011:803948. [PMID: 22363887 PMCID: PMC3262649 DOI: 10.5402/2011/803948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/11/2011] [Indexed: 11/26/2022]
Abstract
In this 12-week open-label, uncontrolled study, patients (n = 85; mean [SD] age 11.2 [3.95] years) were trained to use an injection device with an automatic needle insertion accessory (NordiFlex/NordiFlex PenMate: Novo Nordisk A/S, Bagsvaerd, Denmark) for growth hormone (GH) injection. The opinions of patients and the physicians/nurses who trained patients on device were recorded by questionnaire. Most (88.4%) patients reported that the device was “very easy/easy" to use. The majority (82.4%) of patients were “very satisfied/satisfied" with the device and 64% wished to continue its use. Device training instructions were reported as “very easy/easy" by 96.1% of physicians/nurses, and 65.8% of participants could use the device after ≤10-minute training. In this study, NordiFlex PenMate was well accepted by patients and medical staff. Patients had a high opinion of the device and over half wished to continue its use. High patient acceptance may facilitate treatment adherence optimizing treatment outcomes.
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Affiliation(s)
- Anita Hokken-Koelega
- Department of Paediatrics, Division of Endocrinology, Sophia Children's Hospital/Erasmus University Medical Centre, 3015 GJ Rotterdam, The Netherlands
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Kappelgaard AM, Mikkelsen S, Knudsen TK, Fuchs GS. Patient preference for a new growth hormone injection device: results of an open-label study in Japanese pediatric patients. J Pediatr Endocrinol Metab 2011; 24:489-96. [PMID: 21932587 DOI: 10.1515/jpem.2011.252] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Growth hormone deficiency (GHD) in children is treated with daily subcutaneous injections of GH. Poor adherence, resulting in suboptimal treatment outcomes, is common due to long-term treatment. Injection devices that are considered easy to use by patients or guardians could improve adherence. OBJECTIVE This study assessed the usability of the Norditropin FlexPro pen injector and NovoTwist needles (both Novo Nordisk A/S, Bagsvaerd, Denmark) in Japanese children and adolescents with GHD. METHODS This open-label, uncontrolled usability test included patients aged 6 to < or = 18 years with GHD currently receiving daily injections of GH with pen injectors. Patients performed repeated injections of test medium into a foam cushion. Patients or guardians completed a questionnaire on pen handling. RESULTS A total of 73/74 patients (99%) rated Norditropin FlexPro easy to handle, reporting no technical complaints. In total, 60 (81%) preferred Norditropin FlexPro over their current device, with 12% preferring their current device and 7% not sure. CONCLUSIONS Norditropin FlexPro was perceived as easy to use and reliable, and was well accepted and preferred over the current device for the administration of GH in children and adolescents. Patients were more confident that Norditropin FlexPro delivered the right dose compared with their current device.
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Affiliation(s)
- Anne-Marie Kappelgaard
- University of Aarhus and Growth Hormone Global Marketing, Novo Nordisk A/S, Virum, Denmark.
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29
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Haverkamp F, Gasteyger C. A review of biopsychosocial strategies to prevent and overcome early-recognized poor adherence in growth hormone therapy of children. J Med Econ 2011; 14:448-57. [PMID: 21651428 DOI: 10.3111/13696998.2011.590829] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adherence to growth hormone (GH) therapy among children is variable and remains a problem, possibly affecting growth outcomes and future health, and having economic consequences. OBJECTIVE To provide a review of the issues related to poor adherence to GH therapy in children and describe integrative strategies that may improve adherence. RESULTS Poor adherence may be caused by various factors, affecting both the children and their families. The key reasons for adherence difficulties are psychological/emotional problems, social/everyday problems and technical handling issues of the drug delivery device. Correspondingly a broad range of strategies to address adherence to GH therapy often revolve around counseling and education, not just for the patient but also for the family giving care. LIMITATIONS This review is intended as a general survey of strategies which could help, in clinical practice, to overcome poor adherence to growth hormone therapy in children; it summarizes the representative literature but it does not aim to be a rigorous database literature search in every aspect. CONCLUSIONS If poor adherence is recognized early on during treatment, appropriate steps may be taken to identify barriers that are amenable to change for encouraging the child to adhere to the treatment regimen. A preventative approach may also be considered; for example, doctors could address adherence issues early and train families of children treated with GH to recognize the resources as well as the barriers to adherence. The broad range of different causes for poor adherence demands a great variety of interventions, making it important to individualize optimal treatment behavior. Additionally, economic studies are required to quantify the cost of poor adherence to GH therapy and to show the financial benefits of good adherence.
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Affiliation(s)
- Fritz Haverkamp
- University of Applied ScienceBochum, Immanuel-Kant-Strasse 18–20, Bochum, Germany.
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Bhosle M, Klingman D, Aagren M, Wisniewski T, Lee WC. Human growth hormone treatment: synthesis of literature on product delivery systems and administration practices. J SPEC PEDIATR NURS 2011; 16:50-63. [PMID: 21294835 DOI: 10.1111/j.1744-6155.2010.00267.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To synthesize current literature on recombinant human growth hormone (rhGH) use and to identify areas of research that have received little to no attention in light of administration practice and patient perception/behavior. DESIGN AND METHODS Relevant articles for a systematic review were identified through PubMed. RESULTS A total of 43 articles were identified: 9 (15.9%) studies on product administration practices and 34 (84.1%) on patient behavior patterns. Patients primarily preferred simple, convenient, and easy-to-use delivery devices. However, literature addressing the effect of convenient product administration practices on treatment outcomes using real-world patient/caregiver data is lacking. PRACTICE IMPLICATIONS Better understanding of real-world product administration practices will help nurses identify areas of improvement in patient education and training.
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Affiliation(s)
- Monali Bhosle
- I.M.S. Health, Health Economics and Outcomes Research, Falls Church, Virginia, USA
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31
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Pfützner A, Hartmann K, Winter F, Fuchs GS, Kappelgaard AM, Rohrer TR. Intuitiveness, ease of use, and preference of a prefilled growth hormone injection pen: A noninterventional, randomized, open-label, crossover, comparative usability study of three delivery devices in growth hormone-treated pediatric patients. Clin Ther 2010; 32:1918-34. [DOI: 10.1016/j.clinthera.2010.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2010] [Indexed: 11/30/2022]
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32
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Nickman NA, Haak SW, Kim J. Cost minimization analysis of different growth hormone pen devices based on time-and-motion simulations. BMC Nurs 2010; 9:6. [PMID: 20377905 PMCID: PMC2858139 DOI: 10.1186/1472-6955-9-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 04/08/2010] [Indexed: 11/30/2022] Open
Abstract
Background Numerous pen devices are available to administer recombinant Human Growth Hormone (rhGH), and both patients and health plans have varying issues to consider when selecting a particular product and device for daily use. Therefore, the present study utilized multi-dimensional product analysis to assess potential time involvement, required weekly administration steps, and utilization costs relative to daily rhGH administration. Methods Study objectives were to conduct 1) Time-and-Motion (TM) simulations in a randomized block design that allowed time and steps comparisons related to rhGH preparation, administration and storage, and 2) a Cost Minimization Analysis (CMA) relative to opportunity and supply costs. Nurses naïve to rhGH administration and devices were recruited to evaluate four rhGH pen devices (2 in liquid form, 2 requiring reconstitution) via TM simulations. Five videotaped and timed trials for each product were evaluated based on: 1) Learning (initial use instructions), 2) Preparation (arrange device for use), 3) Administration (actual simulation manikin injection), and 4) Storage (maintain product viability between doses), in addition to assessment of steps required for weekly use. The CMA applied micro-costing techniques related to opportunity costs for caregivers (categorized as wages), non-drug medical supplies, and drug product costs. Results Norditropin® NordiFlex and Norditropin® NordiPen (NNF and NNP, Novo Nordisk, Inc., Bagsværd, Denmark) took less weekly Total Time (p < 0.05) to use than either of the comparator products, Genotropin® Pen (GTP, Pfizer, Inc, New York, New York) or HumatroPen® (HTP, Eli Lilly and Company, Indianapolis, Indiana). Time savings were directly related to differences in new package Preparation times (NNF (1.35 minutes), NNP (2.48 minutes) GTP (4.11 minutes), HTP (8.64 minutes), p < 0.05)). Administration and Storage times were not statistically different. NNF (15.8 minutes) and NNP (16.2 minutes) also took less time to Learn than HTP (24.0 minutes) and GTP (26.0 minutes), p < 0.05). The number of weekly required administration steps was also least with NNF and NNP. Opportunity cost savings were greater in devices that were easier to prepare for use; GTP represented an 11.8% drug product savings over NNF, NNP and HTP at time of study. Overall supply costs represented <1% of drug costs for all devices. Conclusions Time-and-motion simulation data used to support a micro-cost analysis demonstrated that the pen device with the greater time demand has highest net costs.
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Affiliation(s)
- Nancy A Nickman
- Pharmacotherapy Outcomes Research Center, University of Utah, 421 Wakara Way Suite 208, Salt Lake City, Utah 84108, USA
| | - Sandra W Haak
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, Utah 84112-5880, USA
| | - Jaewhan Kim
- Department of Family and Preventive Medicine, School of Medicine, University of Utah; 375 Chipeta Way, Suite A, Salt Lake City, Utah 84108, USA
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Yakushiji F, Fujita H, Terayama Y, Yasuda M, Nagasawa K, Shimojo M, Taniguchi K, Fujiki K, Tomiyama J, Kinoshita H. The best insulin injection pen device for caregivers: results of injection trials using five insulin injection devices. Diabetes Technol Ther 2010; 12:143-8. [PMID: 20105044 DOI: 10.1089/dia.2009.0110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Insulin injection pens have been primarily developed for self-injection among individuals with diabetes. However, an increased elderly population with diabetes has caused an increase in the number of patients who cannot self-inject insulin. Consequently, caregivers inject insulin to the patients ("other-injection"); however, insulin injection devices have not yet been developed for other-injection use. METHODS We evaluated five devices-OptiClik (Sanofi-aventis, Paris, France), SoloStar (Sanofi-aventis), MirioPen without an antiskid tool (Eli Lilly and Co., Indianapolis, IN), MirioPen with an antiskid tool (Eli Lilly, Hyogo, Japan), and FlexPen (Novo Nordisk A/S, Bagsvaerd, Denmark). In all, 22 respondents (mean +/- SD age, 42.6 +/- 9.3 years [range, 26-57 years]), including 11 men (50.0%) and 11 women (50.0%), injected themselves (self-injection) and others (other-injection). Thereafter, respondents evaluated the ease of use and feel of the pen devices via questionnaires. As a result, we evaluated 220 procedures of insulin injections [22 (respondents) x 5 (devices) x 2 (self and other)] in this study. RESULTS FlexPen was selected as the best device for self-injection but as the worst device for other-injection. OptiClik was selected as the second worst device for self-injection but as the best device for other-injection. Moreover, for other-injection, FlexPen was too long and less stable, had poor dial visibility, was difficult to recap, and was comprehensively inferior. CONCLUSIONS We identified problems that were not apparent during studies evaluating conventional self-injection. We conclude that devices meant for other-injection should have different features from those designed for self-injection and that consideration of caregivers' viewpoints is necessary for developing an insulin device specifically meant for other-injection.
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Affiliation(s)
- Fumiatsu Yakushiji
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo 130-8575, Japan.
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Haverkamp F, Johansson L, Dumas H, Langham S, Tauber M, Veimo D, Chiarelli F. Observations of nonadherence to recombinant human growth hormone therapy in clinical practice. Clin Ther 2009; 30:307-16. [PMID: 18343269 DOI: 10.1016/j.clinthera.2008.02.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The effectiveness of all prescribed treatments is contingent on patient adherence. The reported levels of adherence to recombinant human growth hormone (r-hGH) therapy are highly variable, but it has been suggested that nonadherence might be as high as 36% to 49%. OBJECTIVES This commentary discusses the factors that affect long-term adherence to injection treatment, of which r-hGH therapy is a particular challenge. It also explores potential strategies to improve adherence to injection treatments in clinical practice. METHODS The opinion of the authors was validated and supported by published literature. A PubMed literature search was conducted in November 2006, identifying English-language articles containing key terms growth hormone, adherence, and compliance. RESULTS This study found that factors associated with poor adherence to injection treatments include patients' lack of understanding of their disease, patient age, chronicity of the disease, complex treatment regimens, and insufficient information on the implications of nonadherence. Strengthening the patient-physician relationship by providing the patient with a clear understanding of his/her disease and the benefits of adherence, making improvements in injection devices, and eliminating subjective illness concepts, might increase adherence to SC injection treatments, thereby reducing increasing health care costs associated with nonadherence. CONCLUSIONS Poor adherence to r-hGH therapy has a dual effect, in that it leads to reduced efficacy out-comes and increased health care costs. Implementing strategies to improve adherence with injection treatment might be of particular clinical benefit to patients undergoing r-hGH therapy.
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Dahlgren J, Veimo D, Johansson L, Bech I. Patient acceptance of a novel electronic auto-injector device to administer recombinant human growth hormone: results from an open-label, user survey of everyday use. Curr Med Res Opin 2007; 23:1649-55. [PMID: 17559757 DOI: 10.1185/030079907x210589] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure the user acceptance of a electronic auto-injector device (easypod) for recombinant human growth hormone (r-hGH) administration. STUDY DESIGN AND METHODS This was an open-label, uncontrolled study in which participants (n = 61) were trained to use the device to administer subcutaneous recombinant human growth hormone (r-hGH). Participants' opinions on the device were recorded by questionnaire and/or telephone interview during training and after 15 and 60 days of use. Opinions on the device were also collected from nurses or physicians who trained the participants in device use. RESULTS After 60 days, 98% (54/55) of responders reported a 'good' or 'very good' overall impression of the device. The pre-programmed dose feature, skin sensor, on-screen instructions, display of remaining dose, confirmation of injected dose and automatic needle attachment were identified by the majority of participants as 'very useful'. Participants were reported to have easily understood the injection process, and 87% (48/55) expressed a preference to continue use of the device. The device had a good safety profile, and no adverse events were reported during the study or follow-up periods. CONCLUSIONS Participants had a good overall impression of the device and the majority expressed a preference to continue its use. The combination of features offered by the device make it user-friendly, and such ease of use may facilitate greater adherence to treatment, in turn improving therapy outcomes.
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Affiliation(s)
- J Dahlgren
- Queen Silvia Children's Hospital, Göteborg, Sweden.
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Brewer JA, Kanagawa O, Sleckman BP, Muglia LJ. Thymocyte apoptosis induced by T cell activation is mediated by glucocorticoids in vivo. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2002; 169:1837-43. [PMID: 12165507 DOI: 10.4049/jimmunol.169.4.1837] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Glucocorticoids, administered in pharmacological doses, potently modulate immune system function and are a mainstay therapy for many common human diseases. Physiologic production of glucocorticoids may play a role in optimization of the immune repertoire both centrally and peripherally. Possible effects include alteration of lymphocyte development and down-regulation of cytokine responses, but essential roles remain unclear. To determine the part that endogenous glucocorticoids play in thymocyte development, we used fetal liver from mice lacking the glucocorticoid receptor GRko for immunological reconstitution of lethally irradiated wild-type (WT) mice. We find normal numbers and subset distribution of GRko thymocytes. GRko thymocytes also exhibit similar sensitivity to apoptosis induced by activating anti-CD3epsilon Ab as WT thymocytes in vitro. Surprisingly, GRko thymocytes are significantly more resistant than WT thymocytes to anti-CD3epsilon-mediated thymocyte apoptosis in vivo. Consistent with this finding, in vivo TCR complex activation induces sustained high levels of glucocorticoids that correlate strongly with thymocyte apoptosis in WT mice. We find that while direct engagement of the TCR complex may cause death of a subset of thymocytes, glucocorticoids are required for deletion of the majority of thymocytes. Thus, TCR stimulation by Ab administration may more accurately reflect polyclonal T cell activation than negative selection in vivo.
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MESH Headings
- Animals
- Animals, Newborn
- Antibodies/pharmacology
- Apoptosis/drug effects
- Apoptosis/immunology
- Apoptosis/physiology
- CD3 Complex
- Corticosterone/blood
- Dexamethasone/pharmacology
- Female
- Fetus/cytology
- Fetus/immunology
- Fetus/metabolism
- Glucocorticoids/metabolism
- Humans
- Liver/cytology
- Liver/immunology
- Liver/metabolism
- Lung/abnormalities
- Lymphocyte Activation
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/metabolism
- Receptors, Glucocorticoid/deficiency
- Receptors, Glucocorticoid/genetics
- Receptors, Glucocorticoid/metabolism
- T-Lymphocytes/cytology
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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Affiliation(s)
- Judson A Brewer
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
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