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Published on: January 7, 2016
Effectiveness of Recombinant Human Growth Hormone Therapy in Small-for-Gestational-Age Children With Short Stature: A
Sanghee Park1, Yena Lee2, Hwal Rim Jeong3
1Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Insights
Pathogenic genetic variants impact growth outcomes in children with persistent short stature. While recombinant human growth hormone (rhGH) therapy helps, those with variants show a slower growth response over time, emphasizing genetic evaluation for personalized treatment.
Area of Science:
- Pediatric Endocrinology
- Genetics
- Growth Disorders
Background:
- Children born small for gestational age with persistent short stature (SGA-SS) often exhibit growth challenges.
- Genetic factors can significantly influence growth patterns and response to therapy.
Purpose of the Study:
- To assess the influence of pathogenic genetic variants on growth outcomes in SGA-SS children treated with recombinant human growth hormone (rhGH) for three years.
- To compare growth trajectories between genetically characterized SGA-SS patient groups.
Main Methods:
- Retrospective cohort study of 179 SGA-SS children.
- Classification into variant-positive (n=30) and variant-negative (n=149) groups based on genetic evaluation.
- Longitudinal assessment of clinical characteristics and growth outcomes over 3 years of rhGH therapy using linear mixed models.
Main Results:
- Variant-positive children had lower baseline height SDS and higher rates of intellectual disability and congenital anomalies.
- rhGH therapy improved height SDS in both groups after 3 years.
- A progressive attenuation of height SDS gain was observed in the variant-positive group over the treatment period.
Conclusions:
- rhGH therapy is effective for linear growth in SGA-SS children.
- Genetic evaluation is crucial as pathogenic variants are associated with lower baseline stature and reduced growth response to rhGH.
- Personalized treatment strategies informed by genetic findings are important for optimizing growth outcomes in SGA-SS patients.
Objective:
This study aimed to evaluate the impact of pathogenic genetic variants on growth outcomes following 3 years of recombinant human growth hormone (rhGH) therapy in children born small for gestational age with persistent short stature (SGA-SS).
Design:
A retrospective cohort study.
Patients:
One hundred and seventy-nine SGA-SS children who underwent clinical and genetic evaluation were classified into variant-positive (n = 30) and variant-negative groups (n = 149).
Measurements:
Clinical characteristics and growth outcomes were assessed over 3 years of rhGH therapy.
Results:
At baseline, the variant-positive group had significantly lower height standard deviation score (SDS) (-2.83 vs. -2.28, p < 0.001) and higher rates of intellectual disability (36.7% vs. 7.4%, p < 0.001) and congenital anomalies (30.0% vs. 6.7%, p < 0.001). rhGH therapy promoted longitudinal growth in both groups (evaluated n = 142); after 3 years, the estimated marginal mean (EMM) of height SDS reached -1.30 ± 0.10 in the variant-positive group and -0.93 ± 0.04 in the variant-negative group. However, linear mixed model analysis revealed a progressive attenuation of incremental height SDS gain in the variant-positive group as the treatment progressed, with significant interaction estimates observed at Year 1 (Estimate -0.18), Year 2 (Estimate -0.31) and Year 3 (Estimate -0.36; all p < 0.05).
Conclusion:
As one of the first longitudinal analyses utilizing repeated-measures modelling in a genetically characterized patient population, this study demonstrates that while rhGH therapy effectively promoted linear growth in SGA-SS children, patients with a molecular diagnosis presented with lower baseline stature and an attenuated incremental growth response over time, highlighting the importance of genetic evaluation for personalized treatment strategies.
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