Objective. To assess a decade of growth hormone (GH) treatment patterns and outcomes in a real-world setting via the Maccabi Health Services (MHS) database.
Methods: This retrospective database study included all children initiating GH treatment in MHS between January 2004 and December 2014 (n=3325) of whom 2379 were included in the study cohort.
Results: At GH treatment initiation: 62.1% were boys, mean height-SDS (HtSDS) was -2.36±0.65; mean age was 9.8±3.1 years; time from diagnosis of short stature to first GH purchase was 4.8±3.3 years. Mean treatment period was 3.5±0.95 years, 79.4% of children treated for more than 3 years.
The two main indications were: Idiopathic Short Stature (ISS) (n=1615, 67.9%) and growth hormone deficiency (GHD) (n=611, 25.7%). 61.3% of ISS and 59.7% of GHD patients belonged to the upper third of the socio-economic-status (SES).
The overall mean height gain (ΔHtSDS) was 1.35 for GHD and 1.37 for ISS, mainly achieved in the first three years. Final height (age 15 for girls and 17 for boys) was recorded for 624 patients (26.2%) with better outcomes for GHD than ISS (-1.0±0.82 versus -1.28±0.93 respectively, p=0.0002).
Good adherence was achieved in only 78.2% of the cohort during the first year and declined thereafter.
Conclusions: This study revealed that children initiate GH therapy a long period after initial recognition of short stature, belong mainly to the upper SES, and have suboptimal adherence, all more pronounced amongst the ISS group. Appropriate referral, diagnosis and follow-up care may result in better treatment outcomes with GH therapy.
