Clinicians’ Feedback on Patient/Carer Experience After Switching of Growth Hormone Treatment in Pediatric Patients During COVID-19

Figures & data

Table 1 Characteristics of Survey Respondents and Format of Patient Contacts

Number of Clinicians	Total N=106	UK n=24	France n=22	Italy n=30	Japan n=30
Primary medical specialty, %
Endocrinologist	69	71	91	93	27
Pediatrician	27	13	9	7	73
Endocrinology nurse	4	17	0	0	0
Years in practice, mean	19.6	18.9	20.3	18.2	21.1
Time spent on tasks, mean, %
Providing direct patient care	88	82	90	93	85
Performing academic functions	6	6	6	3	7
Administrative functions	5	9	4	3	6
Other professional duties	1	3	0	1	2
Patient contact format since COVID-19, %
Virtual (video, Zoom, Skype etc)	19	25	24	24	6
Telephone-based	17	29	15	20	4
Total for virtual	36	54	39	44	10
In-office visits	61	44	57	51	89
Home visits	3	2	4	5	1
Total for face-to-face	64	46	61	56	90

Note: Percentages have been rounded.

Table 2 Numbers of Pediatric Patients with Diagnosed or Suspected GH-Related Disorders Seen and Treated by the Respondents Since the Start of COVID-19 (February/March 2020) Up to the Point When They Completed the Survey, and Distribution by Age

	All	UK	France	Italy	Japan
Number of clinicians	106	24	22	30	30
Patients seen with diagnosed or suspected GH-related disorders	8369	1868	3033	2665	803
Patients with GH-related disorders treated with GH	5699	1251	1838	2236	374
Patients with GH-related disorders treated with GH, %	68.1%	67.0%	60.6%	83.9%	46.5%
Patients by age category (as percent of GH-treated patients)
4–9 years	31.9%	34.1%	34.8%	25.0%	51.4%
10–12 years	35.6%	32.4%	34.5%	39.2%	29.9%
13–18 years	32.6%	33.5%	30.7%	35.9%	18.7%

Abbreviation: GH, growth hormone.

Figure 1 Clinicians’ attitudes towards GH prescribing since COVID-19, shown as percentage of respondents agreeing with the statements. The red box indicates the statements that received the highest agreement from respondents. *Refers to patient support program and home delivery program provided by a pharmaceutical company. **Refers to pediatric patients with GH-related disorders.

Abbreviation: GH, growth hormone.

Figure 2 Brands identified by clinicians (N=106) as their main/most commonly prescribed therapy for three patient scenarios. Shown as a percentage of the responses for each scenario. Manufacturers of brands are as follows: Genotropin^® – Pfizer; Humatrope^® – Lilly; Omnitrope^® – Novartis; Nutropin AQ^® – Genentech; Zomacton^® – Ferring Pharmaceuticals; Saizen^® – Merck; Growject^® – JCR Pharmaceuticals.

Figure 3 Treatment pathway for pediatric GH patients since the start of COVID-19: proportions (%) of patients switching, initiating new therapy, continuing or discontinuing therapy.

Abbreviation: GH, growth hormone.

Table 3 Patients Switched to Norditropin^®: Demographic Characteristics, Norditropin^® Device Prescribed, and Previous GH Brand: (a) by Country; (b) by Age and Injection Status

(a)
		Total		UK		France		Italy	Japan
Number of PRFs		N=217		n=43		n=47		n=75	n=52
Age, mean, years		9.2		10.1		8.9		9.4	8.6
Gender, male/female, %		62/38		60/40		62/38		57/43	71/29
Injection status: carer/self-injection, %		72/28		67/33		77/23		72/28	71/29
Norditropin^® device^a that patient was switched to: FlexPro^®/SimpleXx^® (NordiPen^®)/Nordiflex^®, %		40/15/45		9/35/56		64/36/0		0/0/100	100/0/0
Brand^b previously used by patients who switched, % of patients
Genotropin^®		45		46		40		35	61
Humatrope^®		21		12		17		24	27
Omnitrope^®		11		14		15		12	4
Nutropin AQ^®		8		5		15		12	0
Zomacton^®		7		18		9		4	0
Saizen^®		6		5		4		13	0
Growject^®		2		0		0		0	8
Therapy duration on previous brand
Mean duration, months		31.9		31.7		34.9		29.6	32.6
(b)
		Age Group (Years)						Injection Status
		4–9		10–12		13–18		Carer-Injected	Self-Injected
Number of PRFs		n=123		n=57		n=37		n=156	n=61
Age, mean, years		6.7		11.0		14.8		8.6	10.8
Gender, male/female, %		54/46		81/19		62/38		61/39	66/34
Injection status by age category, carer/self-injection, %		83/17		61/39		51/49		–	–
Norditropin^® device^a that patient was switched to by category: FlexPro^®/SimpleXx^® (NordiPen^®)/ Nordiflex^®, %		42/15/43		39/14/47		32/16/52		41/16/43	36/11/53
Brand^b previously used by patients who switched, % of patients
Genotropin^®		51		39		26		33	49
Humatrope^®		18		21		29		28	18
Omnitrope^®		11		11		14		11	11
Nutropin AQ^®		6		11		14		11	7
Zomacton^®		4		9		14		5	8
Saizen^®		8		7		0		7	6
Growject^®		2		2		3		1	5
Therapy duration on previous brand
Mean duration, months		26.9		39.5		36.8		30.0	36.8

Notes: ^aNorditropin^® devices were available by country as follows: UK and France: FlexPro^®, SimpleXx^® (NordiPen^®), Nordiflex^®; Italy: Nordiflex^® only; Japan: FlexPro^® only. For details of other brands/devices in use by country, see Supplementary Figure S1; ^bManufacturers of brands are as follows: Genotropin^® – Pfizer; Humatrope^® – Lilly; Omnitrope^® – Novartis; Nutropin AQ^® – Genentech; Zomacton^® – Ferring Pharmaceuticals; Saizen^® – Merck; Growject^® – JCR Pharmaceuticals.

Abbreviation: PRFs, patient report forms.