Managing pediatric growth hormone deficiency requires long-term commitment from young patients and their families. For several decades, daily subcutaneous growth hormone injections served as the cornerstone of therapeutic management. However, this rigorous daily schedule frequently introduces substantial emotional friction and treatment fatigue. Parents often find themselves negotiating with resistant children every single evening. Consequently, clinicians have actively sought approaches that reduce this persistent administrative burden. The advent of once-weekly long-acting growth hormone preparations marks a noteworthy milestone in pediatric endocrinology. Despite regulatory approvals across various global healthcare systems, real-world comparative evidence regarding family experiences remains limited. Therefore, evaluating how caregivers perceive daily versus weekly regimens offers invaluable insights for contemporary pediatric care.

Study Overview: Evaluating Caregiver Experiences in Japan

To address this clinical knowledge gap, a cross-sectional online study evaluated caregivers across Japan between June 14 and June 24, 2024. The study recruited participating caregivers through established Japanese consumer research panels. Eligible participants had administered growth hormone therapy for at least three months to children aged 3 to 14 years diagnosed with pediatric growth hormone deficiency. In total, 187 eligible caregivers successfully completed the detailed survey. Among these participants, 137 caregivers regularly administered once-daily injections, while 50 caregivers managed once-weekly injection regimens. The research team evaluated treatment experiences, caregiver satisfaction, and outstanding unmet clinical needs. Furthermore, investigators used multivariable logistic regression models to identify specific variables independently associated with the caregiver desire to alter injection frequency. Confounding variables, including child age and therapy duration, were carefully adjusted within the statistical analyses. Ultimately, this structured design provided valuable real-world evidence comparing traditional daily therapy directly against modern weekly protocols.

Unmet Needs Surrounding Daily Growth Hormone Injections

Managing pediatric growth hormone therapy involves navigating multifaceted clinical, behavioral, and emotional challenges. When survey respondents ranked their primary unmet needs, injection pain emerged as the foremost concern across the entire study population, cited by 35.8% of respondents. In addition, 29.4% of caregivers highlighted ongoing concerns regarding treatment effectiveness, demonstrating that parents remain highly focused on linear growth velocity. Furthermore, 26.2% of surveyed parents identified injection frequency as a critical unmet need that constantly disrupted routine family life. Interestingly, the comparative analysis revealed no statistically significant difference in perceived injection pain between children receiving daily injections and those receiving weekly formulations. Similarly, overall treatment satisfaction scores, measured through the validated Treatment Satisfaction Questionnaire for Medication version II, remained comparable across both cohorts. Thus, while physical discomfort during administration troubles many families, the logistical cadence of repeated daily injections represents an independent and distinct source of parental stress.

Desire to Switch: Daily Versus Weekly Injection Cohorts

The survey demonstrated striking differences between groups when assessing caregiver attitudes toward altering treatment schedules. Notably, 47.4% of caregivers in the once-daily injection cohort expressed a clear desire to change their administration frequency. In contrast, only 22.0% of caregivers administering once-weekly injections shared this sentiment, demonstrating a statistically significant difference between the two cohorts. Additionally, the reasons underlying current treatment selection highlighted critical gaps in clinical communication. Specifically, 27.7% of daily-injection caregivers reported that they continued their current protocol simply because they lacked the opportunity or clinical guidance to switch. Conversely, only 10.0% of weekly-cohort caregivers reported a similar lack of opportunity. These findings illustrate that nearly half of families managing daily regimens feel dissatisfied with administration frequency. Moreover, many parents remain unaware of alternative therapeutic options simply because clinicians have not actively initiated discussions regarding weekly treatment alternatives during regular outpatient consultations.

Predictors of Caregiver Preference and Statistical Insights

To understand the precise drivers of caregiver preferences, investigators performed a comprehensive multivariable logistic regression analysis. This statistical approach allowed researchers to isolate independent determinants while rigorously adjusting for demographic and disease-related covariates. The analysis established that current once-daily administration served as a powerful independent predictor of the desire to modify injection frequency. Specifically, caregivers administering daily injections had over fivefold higher odds of wanting to change schedules compared to those using weekly formulations. The adjusted odds ratio reached 5.30, with a 95% confidence interval spanning from 2.22 to 13.7. Furthermore, this association remained statistically significant after adjusting for treatment duration and the child's age. Consequently, these robust data confirm that daily administration represents an intrinsic operational friction point for families. Reducing administration frequency from 365 injections annually to roughly 52 injections visibly alleviates a profound logistical and emotional barrier for pediatric caregivers.

Translating Real-World Findings into Pediatric Practice

These real-world insights hold meaningful clinical implications for pediatric endocrinologists and general practitioners worldwide, including in developing healthcare landscapes. When managing pediatric growth hormone deficiency, physicians often focus primarily on biochemical markers and linear growth velocity. However, long-term therapeutic success fundamentally depends upon sustained adherence over many years. Missed daily doses compromise final adult height and inflate overall healthcare expenditure. Therefore, proactive dialogue regarding injection frequency represents an essential element of modern, patient-centered pediatric endocrinology. Clinicians should not assume that silent caregivers are satisfied with daily injections. Instead, healthcare providers must routinely explore treatment burden, injection anxiety, and scheduling conflicts during routine follow-up consultations. Offering eligible families a choice between daily and weekly regimens fosters shared decision-making. As long-acting growth hormone formulations become increasingly available, proactive clinical communication will empower caregivers, alleviate administrative burdens, and optimize long-term pediatric therapeutic adherence.

How does weekly growth hormone therapy compare to daily therapy regarding efficacy?

Clinical trials and real-world studies show that once-weekly long-acting growth hormone therapies provide noninferior efficacy compared to conventional daily somatropin injections. Specifically, both treatment modalities achieve similar annualized height velocity and normalized insulin-like growth factor-1 standard deviation scores in pediatric growth hormone deficiency. Furthermore, weekly regimens deliver comparable safety and tolerability profiles, making them an effective alternative for maintaining healthy childhood linear growth.

Why do caregivers frequently request to switch away from daily injections?

Caregivers frequently seek to switch from daily injections because administering daily subcutaneous therapy induces persistent psychological stress, child resistance, and scheduling difficulties. Managing 365 injections each year disrupts family evening routines and increases parental anxiety regarding missed doses. In contrast, moving to a once-weekly regimen drastically cuts injection frequency by over eighty percent, substantially decreasing treatment burden while preserving family harmony and patient compliance.

Did the Japanese survey identify differences in perceived injection pain between regimens?

Surprisingly, the Japanese cross-sectional survey found no statistically significant difference in perceived injection pain between the once-daily cohort and the once-weekly cohort. Although injection pain remained the top overall unmet need reported by thirty-five percent of caregivers, weekly injections did not provoke greater perceived discomfort. Therefore, clinicians can reassure apprehensive families that reducing injection frequency does not compromise local injection site comfort.

Disclaimer: This content is for informational and educational purposes only... Refer to the latest local and national guidelines for clinical practice.

References

Takasawa K et al. Caregiver Experiences with Daily and Weekly Growth Hormone Injections in Japanese Children: A Cross-sectional Survey. Drugs Real World Outcomes. 2026 Nov 02. doi: 10.1007/s40801-026-00595-1. PMID: 42970025.

Maniatis AK, Carakushansky M, Galcheva S, et al. Treatment burden of weekly somatrogon vs daily somatropin in children with growth hormone deficiency: a randomized study. J Endocr Soc. 2022;6(10):bvac117.

Brod M, Højbjerre L, Alolga SL, Beck JF, Wilkinson L, Rasmussen MH. Understanding treatment burden for children treated for growth hormone deficiency. Patient. 2017;10(5):653-666.