Adult growth hormone deficiency: clinical advances and approaches to improve adherence

Abstract

Introduction: There has 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 nonadherence 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.

Similar safety and efficacy in previously treated adults with growth hormone deficiency randomized to once‐weekly somapacitan or daily growth hormone

“…22 Nonadherence and nonpersistence with daily GH therapy are likely to lead to poorer treatment outcomes in patients with AGHD. 7 Reported rates of GH therapy discontinuation range from 13.3% to 58.9%, 23 with burden of daily GH injections, lack of awareness regarding GH health benefits, side effects and poor adherence reported as common reasons for GH discontinuation. 5,6,23 Thus, reducing the frequency of injections with a long-acting GH replacement may improve treatment adherence and persistence, and consequently treatment outcomes.…”

“…7 Reported rates of GH therapy discontinuation range from 13.3% to 58.9%, 23 with burden of daily GH injections, lack of awareness regarding GH health benefits, side effects and poor adherence reported as common reasons for GH discontinuation. 5,6,23 Thus, reducing the frequency of injections with a long-acting GH replacement may improve treatment adherence and persistence, and consequently treatment outcomes. 7 Johannsson et al 11 reported that once-weekly somapacitan was rated as more convenient than daily GH by patients with AGHD.…”

GH Replacement in the Elderly: Is It Worth It?

“…In Italy it is established at 9 µg/l in the normal-weight and at 4.2 µg/l in obese people (BMI > 30 kg/m 2 ) ( 26 ). In the United States, where GHrh was withdrawn from the market in 2008, the better test for EGHD diagnosis seems to be Macimorelin, which has excellent tolerability and minimal side effects ( 27 ), despite several pharmacological interferences ( 28 ).…”

“…Side effects consist primarily on fluid retention and increase in insulin resistance, typically seen at the beginning of therapy and/or after the increase of the dose. Adverse events are more common in the elderly and, generally, disappear with dose reduction or end of therapy ( 18 , 28 , 32 ).…”

Sensitivity and specificity of the macimorelin test for diagnosis of AGHD

“…Treatment of AGHD with growth hormone (GH) replacement therapy has been shown to improve many, but not all, of the clinical features of AGHD (14). However, the diagnosis of AGHD is challenging because the clinical presentation of this syndrome is often nonspecific, with many features resembling those of metabolic syndrome (15,16).…”