Improvement of patient convenience in treatment with growth hormone.

Patient compliance is of vital importance for the outcome of any medical therapy. Compliance is a problem especially in the treatment of non-life-threatening conditions, such as growth retardation in children, where motivation can be low and the rewards delayed. One way to improve compliance is through an improvement in patient convenience. As a result of these considerations as well as the positive experiences reported with insulin pen treatment, an injection pen for growth hormone administration (Nordiject) has been introduced. Results from several patient acceptance studies have shown that the injection pen and the preparation for use in the pen have been found effective and safe with good local tolerability and reduced perception of injection pain. The injection pen was found to simplify the injection procedure and was strongly preferred to conventional syringes and vials. Special attention has been paid to local discomfort and injection pain. A double-blind, randomized cross-over study has shown that 0.9% benzyl alcohol solvent causes statistically significantly less local discomfort that a 0.25% metacresol solvent when used for reconstitution of growth hormone. In another study the 30G needle was compared with 27G, and the use of the 30G needle seems also to give a reduction in injection pain. A further reduction in injection pain can be gained by improving the needle insertion technique. A randomized cross-over study compared two experimental devices, one with manual and one with automatic needle insertion. The results from this study showed a statistically significantly lower injection pain score for the automatic device compared to the manual. The above studies have shown that it is possible to improve patient convenience. Long-term studies will show whether this improvement results in improved compliance and hence a better treatment outcome.