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[Growth hormone therapy in children with growth hormone deficiency: study of dose-response relationship]
J Lebl1, D Zemková, S Kolousková
12. dĕtská klinika 2. LF UK a Fakultní nemocnice v Praze-Motole.
Insights
The therapeutic dose of growth hormone significantly impacts treatment effectiveness in children with growth hormone deficiency. Individualizing the growth hormone dose based on patient characteristics optimizes height outcomes.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Child Development
Context:
- Children with growth hormone deficiency (GHD) often receive a standardized growth hormone (GH) dose regardless of individual factors.
- Optimizing GH therapy requires understanding variables that influence treatment response.
- Personalized therapeutic strategies aim to achieve catch-up growth at an appropriate age.
Purpose:
- To investigate the impact of different growth hormone dosages on growth rate and height gain in prepubertal children with GHD.
- To identify key predictors of therapeutic response to growth hormone treatment.
Summary:
- A one-year study treated 25 prepubertal children with GHD using three different daily subcutaneous growth hormone dosages (0.42, 0.7, and 1.0 IU/kg/week).
- Higher growth hormone doses led to significantly increased growth rates and greater increases in height age.
- Therapeutic dose was the primary predictor of growth rate, followed by target height.
Impact:
- Findings suggest that the therapeutic dose is the most critical factor in predicting growth hormone efficacy in children with GHD.
- Individualizing growth hormone dosage based on patient characteristics and therapeutic goals is recommended for optimal treatment outcomes.
- This research supports tailored approaches to GH therapy for improved height attainment in children with GHD.
Background:
Despite different age, stature, severity of hormone deficiency and target height children with growth hormone deficiency are usually given a uniform therapeutic dose of the preparation. Knowledge of the basic variables which influence individual therapeutic effects of growth hormone would make it possible to elaborate for individual patients a specific therapeutic strategy with the aim to cath up with the deficiency in height at an appropriate calendar age.
Methods And Results:
The authors treated for a period of one year, using three different dosages of growth hormone, 25 prepubertal children with growth hormone deficiency (post-stimulation level < 8 mIU/l). Group A (9 children aged 11.2 +/- 2.0 years) were treated with 0.42 IU/kg/week, group B (7 children, aged 11.4 +/- 4.6 years) 0.7 IU/kg/week and group C (9 children, aged 10.2 +/- 2.4 years) 1.0 IU/kg/week. The preparation was administered daily before bedtime by the s.c. route. The growth rate during treatment increased from (mean +/- SD) 2.6 +/- 0.9 to 9.3 +/- 1.5 cm/year (group A), from 2.3 +/- 1.0 to 10.4 +/- 2.5 cm/year (group B) and from 3.1 +/- 0.7 to 12.6 +/- 1.9 cm/year (group C, p < 0.05 as compared with group A). The height age increased per year of treatment significantly more in children of group C (by 2.1 +/- 0.3 year) than in group A (by 1.6 +/- 0.3 year) or in group B (by 1.7 +/- 0.3 year). No difference was found between the groups in the ratio of changes in height and bone age. From 10 analyzed variables the growth rate during treatment is predicted above all by the therapeutic dose (r = 0.60), and to a lesser extent by the target height (r = 0.53).
Conclusions:
The therapeutic dose is the decisive parameter for prediction of the therapeutic effect of growth hormone in children with growth hormone deficiency. It is justified to modify the therapeutic dose individually with regard to the initial characteristic and therapeutic target of every given patient.