Growth hormone prescribing patterns in the UK, 2013-2016

Area of Science:

• Pediatric Endocrinology
• Growth Hormone Therapy
• Clinical Audit

Background:

• Recombinant human growth hormone (rhGH) is prescribed for growth failure in UK children based on National Institute for Health and Care Excellence (NICE) guidance.
• The British Society for Paediatric Endocrinology and Diabetes (BSPED) initiated a national audit in 2013 to examine rhGH prescribing practices.
• This review analyzes rhGH prescribing data in children and adolescents in the UK between 2013 and 2016.

Purpose of the Study:

• To assess prescribing practices for recombinant human growth hormone (rhGH) in UK children and adolescents.
• To analyze trends in licensed versus unlicensed rhGH prescribing between 2013 and 2016.
• To examine patient demographics and indications for rhGH initiation.

Main Methods:

• Inclusion criteria: Patients ≤16 years of age starting rhGH for licensed and unlicensed conditions in the UK.
• Data collected: Anonymised data on indication and patient demographics.
• Analysis period: 2013–2016, covering 3757 patients from 89% of UK centers.

Main Results:

• Prescribing proportions for licensed indications remained stable: 56% growth hormone deficiency (GHD), 17% small for gestational age (SGA), 10% Turner syndrome, 6% Prader-Willi syndrome (PWS), 3% chronic renal insufficiency (CRI), and 2% short stature homeobox deficiency (SHOXd).
• Unlicensed rhGH prescribing decreased from 10% in 2013 to 5% in 2016.
• Patients with PWS were significantly younger (median 2.2 years) at rhGH initiation compared to other indications. Boys predominated in GHD, SGA, and CRI groups but not in PWS or SHOXd.

Conclusions:

• Significant engagement of prescribing centers was demonstrated in the national audit.
• A substantial decline in unlicensed rhGH prescribing was observed over the 4-year period.
• Younger age at initiation and a lack of male predominance were noted in the PWS group compared to other indications.