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Treatment of GH-deficient children with two different GH doses: effect on final height and cost-benefit implications
Giorgio Radetti1, Fabio Buzi, Claudio Paganini
1Department of Paediatrics, Regional Hospital of Bolzano, via L Boehler No. 5, 39100 Bolzano, Italy. giorgio.radetti@asbz.it
Insights
Higher doses of recombinant human growth hormone (rhGH) significantly increased final height in children with growth hormone deficiency (GHD). This treatment also improved height relative to genetic potential without affecting glucose tolerance.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Childhood Growth Disorders
Background:
- Previous studies suggest higher recombinant human growth hormone (rhGH) doses increase growth velocity and final height in children with growth hormone deficiency (GHD).
- However, these findings were based on heterogeneous patient groups, necessitating verification in well-matched cohorts.
Purpose of the Study:
- To investigate the efficacy of higher rhGH doses compared to conventional doses in well-matched groups of children with isolated GHD.
- To determine if higher rhGH doses lead to improved final height and height gain relative to target height.
Main Methods:
- Two groups of 13 children with isolated GHD were selected, matched for age, sex, and height standard deviation score (SDS).
- Group A received a weekly rhGH dose of 0.3 mg/kg, while Group B received 0.15 mg/kg.
- Patients were followed until final height was achieved.
Main Results:
- Group A (higher rhGH dose) achieved a significantly higher final height SDS (-0.45 vs -1.07) and height gain SDS (1.81 vs 1.23) compared to Group B.
- The difference between final height SDS and target height SDS was positive and significantly higher in Group A (0.33 vs -0.46).
- Glucose tolerance remained normal in all patients, including those receiving higher rhGH doses.
Conclusions:
- Higher doses of rhGH significantly improve final height in children with GHD, even in relation to their genetic target height.
- The economic implications of higher-dose rhGH treatment should be considered in clinical evaluations.
Objective:
Treatment of GH-deficient (GHD) children with higher doses of recombinant human GH (rhGH) than conventional ones has been reported to result in higher growth velocity and increased final height. These findings, however, were observed by comparing large but heterogeneous groups of children. We wanted to verify whether the same results could be obtained in two groups of appropriately well-matched children with isolated GHD treated with high vs conventional doses of rhGH.
Methods:
Out of two cohorts of GHD children, cohort A (on a weekly rhGH dose of 0.3 mg/kg body weight) and cohort B (on a weekly rhGH dose of 0.15 mg/kg body weight), we selected two groups, each including 13 patients, who before treatment were matched for age, sex and height standard deviation score (SDS). They were followed up until final height.
Results:
Final height SDS was significantly higher in group A (-0.45+/-0.36 (s.d.) vs -1.07+/-0.7; P=0.008), as well as height gain SDS (1.81+/-0.58 vs 1.23+/-0.62; P=0.002). The difference between final height SDS and target height SDS was positive only in group A and significantly higher in group A than in group B (0.33+/-0.51 vs -0.46+/-0.7; P=0.01). Glucose tolerance was always normal in the group treated with higher doses.
Conclusion:
The final height of children treated with higher doses of rhGH is increased, also in relation to their genetic target. The economical burden of this choice of treatment, however, has to be taken into account when evaluating the results.