Growth Hormone Utilization Review in a Pediatric Primary Care Setting

Area of Science:

• Pediatric Endocrinology
• Pharmacoeconomics
• Medication Use Evaluation

Background:

• Ensuring rational use of high-cost medications is a significant public health challenge.
• Medication use evaluation (MUE) is a critical tool for optimizing drug therapy.
• Recombinant human growth hormone (GH) is a high-cost medication requiring careful usage assessment.

Purpose of the Study:

• To evaluate specific aspects of recombinant growth hormone (GH) utilization in pediatric patients.
• To assess the appropriateness of GH indications, dosing, monitoring, and discontinuation.
• To identify potential areas for improving GH therapy management.

Main Methods:

• A cross-sectional study was conducted from August 2012 to August 2014.
• Included children receiving GH ± gonadotropin releasing hormone (GnRH) analogs.
• Utilized a researcher-designed checklist to collect data from medical records on demographics, clinical data, and drug therapy aspects.

Main Results:

• Seventy children were included; 32.85% received GH and GnRH analogs concurrently.
• Baseline assessments included GH stimulation tests (95.7%), IGF-1 levels (90%), thyroid function tests (95.71%), and bone age determination (97.14%).
• Mean GH doses varied by indication; monitoring of height, weight, IGF-1, and thyroid function was generally consistent, though annual bone age evaluation was less frequent (43.33%). Financial issues led to discontinuation in 21.42% of patients.

Conclusions:

• Diagnostic testing and monitoring of key parameters like height, weight, IGF-1, and thyroid function were appropriately conducted.
• A subset of patients with idiopathic short stature (ISS) and Turner syndrome were identified as being under-dosed with GH.
• The study highlights the need for continued vigilance in optimizing GH dosing for specific pediatric conditions.