Innovation has driven Merck’s growth and performance to its 350-year celebration in 2018.
We recognise that while product advances lie at the core of innovation in healthcare, it is the development and implementation of new technologies to address patients’ needs that is critical moving forward.
This is true for many of the therapeutic areas that Merck is involved in, and nowhere is the evolution of new technologies more evident than in our approach to the management of growth hormone diseases (GHD). In this area, I have seen the adoption of eHealth initiatives bring significant benefits in medicine adherence, while the progress in chronic disease management has recently led to industry recognition with PMEA’s Excellence in Innovation award for the company’s growth hormone eHealth initiatives.
Medications management and eHealth
The reference treatment for patients with GHD is based on recombinant human growth hormone (rhGH) which is identical to the growth hormone produced by the pituitary gland. Growth hormone treatment (GHT) is only available on prescription and is given as a subcutaneous injection (directly under the skin). Patients, often with the help of their parents or caregivers, need to inject the GHT on a daily basis with most treatment regimes.
With early diagnosis and a continuous treatment, children generally achieve ‘good treatment’ outcome when it comes to height development. To achieve this high level of adherence, the treatment requires a long-term commitment from patients, caregivers, nurses and physicians. For children with GHD, maintaining a high adherence to the treatment is crucial to reach their height potential, as the growth hormone dose is one of the biggest contributors to the final height gain. However, historically, this only adds to the burden of the condition on the children and their caregivers given the length of the treatment, which on average takes 9.4 years.
A decade ago, Merck decided to reduce the treatment burden in GHD and quickly recognised the potential of digital technology and processes to drive innovation in treating GHD through better devices and services. As a result, over the last ten years, we have built an eHealth ecosystem which delivers benefits in three critical areas of modern medicines management for growth hormone disorders: patient engagement, monitoring and adherence.
Engaging younger patients
At the heart of our treatment approach in growth hormone disorders lies the first electronic fully auto-injection device. The device was developed to improve patient convenience and comfort. The automated injection device provides reliable data for the treatment of GHD and makes injections simple for the patient to administer.
We have also developed a GH treatment-supporting, educational smartphone application that combines gaming with facts and tips about taking their medicine with the auto-injection device, which allows children with GHD to have fun while learning more about their condition and GH treatment.
Patient-centric by design, the device, along with the related app, also aims to inform/educate and empower patients to engage with, and self-manage, their condition. This can be especially crucial in a disease such as GHD, where injections are administered on a daily basis (preferably by the patients themselves or alternatively caregivers for the younger ones) over a long period of time, and where the majority of patients are at an age where they value their privacy and don’t necessarily want their parents looking over their shoulders every time they medicate.
Remote monitoring
Our auto-injection device uses real-time and continuous monitoring, which not only gives patients more control over their own health, but also stores the date, time and status (complete, partial, missed) of each injection, and uploads this data wirelessly from the patients’ homes to the healthcare professionals (HCP).
This enables HCPs to appropriately intervene when necessary, make treatment decisions based on real-time data going forward, as well as allowing them to obtain a better understanding of the impact the drug is having on their patients.
A breakthrough to unlock adherence
Medication adherence often defines effectiveness of a treatment programme and improving patients’ compliance with their medicine can be the single most impactful intervention for improving health outcomes.
However, patient adherence remains a universal challenge for many conditions and represents a significant drain on global healthcare systems. In the EU alone, it has been estimated that there are nearly 200,000 deaths a year due to missed doses and non-adherence of prescribed medication, with non-adherence estimated to cost EU governments €125bn annually.
Adherence to treatment in patients with long-term conditions such as growth hormone deficiency is particularly challenging, with 50% of patients failing to adhere to their prescribed regimen.
As GHD requires daily hormone injections and mostly affects children and teenagers, medication adherence can be a real and ongoing struggle for all those involved in the treatment process. To tackle patient adherence to treatment, we need to turn our focus to medication-taking behaviour, which we believe requires a more patient-centred, collaborative multi-stakeholder approach – one such approach being the incorporation of eHealth into daily healthcare practice.
To validate our innovative approach in GHD, Merck embarked on the first long-term, multinational observational study of an eHealth intervention. The first results from the global, five-year observational study in children with growth disorders was presented at the 10th International Meeting of Pediatric Endocrinology in September 2017. The findings showed high adherence levels to growth hormone (GH) therapy administered via the auto-injection device, which were maintained over time and associated with positive growth outcomes.
This is a landmark study for eHealth in general as the findings offer the first large-scale evidence which suggests that using an eHealth platform can have a positive impact on treatment adherence in growth disorders. This data adds to the mounting proof that auto-injection devices can help physicians to effectively monitor growth hormone treatment adherence and, thus, improve clinical outcomes. Indeed, simply providing information to patients and parents/caregivers on the importance of adherence for achieving treatment goals may improve subsequent adherence.
eHealth is transforming decision-making, information-sharing and patient education, all of which are improving patient outcomes. We were delighted that PMEA recognised our eHealth programme with the award for Excellence in Innovation and we will continue to strive to create a new era in the management of growth hormone deficiency, one in which patients and their families are more empowered.