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Dose-response curves for treatment with biosynthetic human growth hormone
F Darendeliler1, P C Hindmarsh, C G Brook
1Endocrine Unit, Middlesex Hospital, London.
Insights
Biosynthetic human growth hormone (GH) therapy significantly improves growth velocity in short children. Higher doses of GH lead to greater growth responses, particularly in children with severe GH insufficiency, optimizing treatment plans.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Child Development
Background:
- Short stature in children can result from various factors, including growth hormone (GH) deficiency.
- Assessing pretreatment height velocity is crucial for predicting growth response to GH therapy.
Purpose of the Study:
- To investigate the dose-dependent effects of biosynthetic human GH on growth response in short prepubertal children.
- To determine how pretreatment height velocity influences the efficacy of GH therapy.
Main Methods:
- A study involving 90 short prepubertal children (aged 3.1-12.9 years) receiving biosynthetic human GH.
- Children were stratified into three groups based on pretreatment height velocity standard deviation scores (SDS): normal growth, moderate GH insufficiency, and severe GH insufficiency.
- The impact of varying GH doses (mean 16 units/m2/week) on height velocity SDS changes over one year was analyzed.
Main Results:
- GH therapy significantly increased height velocity SDS across all groups.
- Children with severe GH insufficiency (Group C) showed the most substantial increase in height velocity SDS (+7.0).
- Moderate GH insufficiency (Group B) and short normal growing children (Group A) experienced increases of +4.3 and +2.9 SDS, respectively.
Conclusions:
- The dose of GH administered is a dominant factor influencing growth response within each pretreatment height velocity group.
- These findings support individualized treatment strategies for children with GH insufficiency, tailoring doses to predicted response.
- Optimizing GH therapy based on pretreatment growth characteristics can maximize growth outcomes in short children.
Abstract:
We have studied the effect of varying doses of biosynthetic human GH on the growth response over the first year of therapy in 90 short prepubertal children (67 males and 23 females, aged 3.1-12.9 years). As pretreatment height velocity was the predominant determinant of response, the children were divided into three groups on the basis of their pretreatment height velocity standard deviation scores (SDS). Group A (n = 27) had pretreatment height velocity SDS between +1.3 and -0.8 (short normal growing children), group B (n = 35) between -0.9 and -2.0 (moderate GH insufficiency) and group C (n = 28) less than -2 (severe GH insufficiency). Within each group, the dose of GH administered was the dominant factor in the regression. At a mean dose of 16 units/m2 body surface area per week, the change in height velocity SDS over the first year of therapy was +2.9 (95% confidence interval (CI) 2.4, 3.5) in group A, +4.3 (95% CI 3.9, 4.6) in group B and +7.0 (95% CI 6.0, 8.0) in group C. These values translate into increases in growth rate of 2.2, 3.4 and 5.5 cm/year for an 8-year-old in each group respectively. These results have important implications in planning the treatment of children with GH insufficiency.