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Dosing of growth hormone in growth hormone deficiency
M B Ranke1, R Schweizer, H A Wollmann
1University Children's Hospital, Tübingen, Germany.
Insights
Growth hormone (GH) treatment for children with GH deficiency (GHD) requires individualized dosing strategies. Optimizing treatment protocols is crucial for achieving satisfactory adult height outcomes.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Metabolic Disorders
Background:
- Current growth hormone (GH) treatment protocols for GH-deficient (GHD) children are largely standardized globally.
- Standardized subcutaneous daily injections of recombinant 22 kDa GH are common, with prepubertal dosing mimicking natural production rates.
- Significant variations in prescribed GH dosages exist, influenced by national regulations and reimbursement policies, leading to suboptimal outcomes.
Purpose of the Study:
- To highlight the need for individualized GH dosing strategies to optimize height development in GHD children.
- To address the lack of standardization in GH dosing during puberty and its impact on adult height.
- To propose the use of prediction algorithms and monitoring of response variables for personalized GH therapy.
Main Methods:
- Review of current standardized GH treatment protocols for GHD.
- Analysis of factors contributing to dosage variations and their impact on treatment efficacy.
- Discussion on the potential of individualized dosing strategies, including prediction algorithms and response monitoring.
Main Results:
- Standardized GH dosing, particularly during puberty, often leads to unsatisfactory adult height outcomes.
- Wide variations in GH dosage exist due to differing national guidelines and reimbursement regulations.
- The current approach does not consistently achieve optimal height development for all GHD children.
Conclusions:
- Individualized GH dosing strategies are essential for optimizing height development throughout childhood, puberty, and adulthood.
- Implementing prediction algorithms and monitoring treatment response variables are key to achieving therapeutic goals effectively and safely.
- Personalized GH therapy can improve efficacy, safety, and cost-effectiveness in managing GHD.
Abstract:
Growth hormone (GH) treatment of GH-deficient (GHD) children is to a certain extent standardized worldwide. Recombinant 22 kDa GH is injected once daily by the subcutaneous route, mostly in the evening. The amount of GH injected (calculated per kg body weight or body surface area, expressed in terms of IU or mg) in prepubertal children mimics the known production rate (approximately 0.02 mg [0. 06 IU]/kg body weight per day). However, there is a wide variation in dosage, the reasons for which are partly unknown and partly due to national traditions and regimes imposed by authorities regulating reimbursement. The situation during puberty is less standardized, with most clinicians still not increasing the dosage according to known production rates. The results of these approaches in terms of adult height outcome are not always satisfactory. In order to achieve optimal height development during childhood, puberty and adulthood, strategies must be developed to individualize GH dosing according to set therapeutical goals taking into account efficacy, safety and cost. The implementation of prediction algorithms will help us to reach these goals. In addition, other response variables will have to be monitored during treatment in order to correct for deficits resulting from GHD.