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Clinical Pearls for Transitioning from Daily GH to LAGH Therapy

  1. Welcome to a new accredited tweetorial on Growth Hormone Deficiency in anticipation of our GHD Academy going live on March 19th in collaboration with the wonderful Human Growth Foundation. This tweetorial provides 0.25 AMA PRA Category 1 Credits. #CME.

  2. Statement of accreditation and disclosures can be found at https://app.medall.org/c/medall-endocrinology/resources/cme-growth-disorders. This program has been supported by an independent medical education grant from Novo Nordisk and is delivered in joint providership with AffinityCE

  3. 🧵 Why consider transitioning from daily GH to Long-Acting GH (LAGH)?

⚠️ High non-adherence rates (up to 71%) with daily GH due to injection fatigue, inconvenience, pain, and lifestyle disruption. LAGH may improve adherence. #GHD #EndoTwitter

  1. 📌 Who is the right candidate for LAGH? Consider patients with: ✔️ History of poor adherence ✔️ Multiple injections (other medications) ✔️ Adolescents with busy lifestyles ✔️ Transition-age youth ✔️ No cancer history or severe glucose intolerance

  2. 📉 Do you know the main reasons for non-adherence to daily GH?

✔️ Injection fatigue ✔️ Pain or discomfort ✔️ Perceived treatment burden ✔️ Life circumstances

  1. 🔄 Transitioning Effectively: Key steps: ✔️ Set realistic expectations about therapy outcomes ✔️ Address patient/caregiver concerns (injection fears, adherence) ✔️ Educate on potential IGF-I fluctuations (peak/trough) ✔️ Clarify differences from daily GH
  1. 📅 IGF-I Monitoring Timing: LAGH therapy requires precise IGF-I sampling: ✔️ Ideal: 4-5 days post-dose ✔️ Incorrect timing → inappropriate dose adjustments
  1. ⚠️ Practical considerations in LAGH dosing: ✔️ Higher dose: younger patients, women on oral estrogen ✔️ Lower dose: older patients, obesity, diabetes risk ✔️ Avoid in severe liver impairment, active malignancy Tailored dosing optimizes outcomes & minimizes risk.
  1. ⚖️ Communication is Key: Clear, patient-centered discussions improve adherence & outcomes: ✔️ Set realistic expectations ✔️ Address fears & misconceptions about GH therapy ✔️ Highlight treatment benefits clearly
  1. 🚨 Pitfalls & Precautions: Be cautious: ✔️ Limited data in cancer survivors & patients with residual tumors ✔️ Higher risk populations need individual assessment

  1. 📈 Monitoring LAGH Therapy: Assess regularly: ✔️ IGF-I levels (use correction factors) ✔️ Clinical efficacy (growth, metabolic parameters) ✔️ Adverse effects, comorbidities

  2. 📌 Key Takeaways: Transitioning from daily GH to LAGH can boost adherence and QoL. Patient selection, careful monitoring, and open communication are essential for success.

  1. 🔗 Join our live session on March 19th for deeper insights! What’s your biggest challenge in transitioning patients? Let’s discuss! #MedEd #EndoTwitter

Thank you for participating in this tweetorial! We hope you are as excited about the future of #GHD as we are! Claim your FREE credit NOW at https://medall.org/GHDtweetorial2 and follow us for more CE/#CME!