Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?

Joanna Smyczyńska; Maciej Hilczer; Andrzej Lewinski; Urszula Smyczyńska; Renata Stawerska

doi:10.5114/pedm.2021.112694

eISSN: 2083-8441
ISSN: 2081-237X

Pediatric Endocrinology Diabetes and Metabolism

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abstract:

Original paper

Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?

Joanna Smyczyńska

¹

,

Maciej Hilczer

²

,

Andrzej Lewinski

^{2, 3}

,

Urszula Smyczyńska

⁴

,

Renata Stawerska

^{2, 5}

Department of Pediatrics, Diabetology Endocrinology and Nephrology, Medical University of Lodz, Poland
Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital – Research Institute in Lodz, Poland
Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland
Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland
Department of Pediatric Endocrinology, Medical University of Lodz, Poland

Pediatr Endocrinol Diabetes Metab 2021; 27 (4): 258–265

DOI: https://doi.org/10.5114/pedm.2021.112694

Online publish date: 2021/12/30

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AMA

Smyczyńska J, Hilczer M, Lewinski A, Smyczyńska U, Stawerska R. Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?. Pediatric Endocrinology Diabetes and Metabolism. 2021;27(4):258-265. doi:10.5114/pedm.2021.112694.

APA

Smyczyńska, J., Hilczer, M., Lewinski, A., Smyczyńska, U.,  & Stawerska, R. (2021). Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?. Pediatric Endocrinology Diabetes and Metabolism, 27(4), 258-265. https://doi.org/10.5114/pedm.2021.112694

Chicago

Smyczyńska, Joanna, Maciej Hilczer, Andrzej Lewinski, Urszula Smyczyńska,  and Renata Stawerska. 2021. "Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?". Pediatric Endocrinology Diabetes and Metabolism 27 (4): 258-265. doi:10.5114/pedm.2021.112694.

Harvard

Smyczyńska, J., Hilczer, M., Lewinski, A., Smyczyńska, U.,  and Stawerska, R. (2021). Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?. Pediatric Endocrinology Diabetes and Metabolism, 27(4), pp.258-265. https://doi.org/10.5114/pedm.2021.112694

MLA

Smyczyńska, Joanna et al. "Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?." Pediatric Endocrinology Diabetes and Metabolism, vol. 27, no. 4, 2021, pp. 258-265. doi:10.5114/pedm.2021.112694.

Vancouver

Smyczyńska J, Hilczer M, Lewinski A, Smyczyńska U, Stawerska R. Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?. Pediatric Endocrinology Diabetes and Metabolism. 2021;27(4):258-265. doi:10.5114/pedm.2021.112694.

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Introduction
Apart from growth promotion, growth hormone (GH) has important metabolic effects. Patients with severe GH deficiency (GHD) should be treated with GH throughout life. Current criteria for growth promoting therapy withdrawal in Poland differ from the latest recommendations.

Aim of the study
To assess cost-effectiveness and safety of continuation of GH therapy in growth promoting doses in patients with isolated GHD after the attainment of near-final height (near-FH) and the incidence of persistent GHD after the therapy withdrawal.

Material and methods
160 children with isolated GHD (height < 3 centile, GH peak < 10.0 µg/l), who continued GH therapy for growth promotion after the attainment of near-FH (height velocity < 2.5 cm/year, bone age ≥ 16 years in boys, ≥ 14 years in girls). Clinical endpoints were: absolute height gain after near-FH, GH dose – cumulative and recalculated for additional 1.0 cm of height, number of injections, incidence of increased IGF-1 concentrations (IGF-1 SDS > 2.0) at near-FH and incidence of severe GHD in retesting (performed in 62 patients).

Results
Height gain after near-FH was 1.1 ±0.8 cm in boys and 1.0 ±0.8 in girls. Increase of height by 1.0 cm required on average 487 mg of GH (264 injections). IGF-1 concentrations at near-FH were increased in 39 patients, with no clinical side effects. None of the patients retested had GH peak < 3.0 µg/l, while 37 (60%) had GH peak > 10.0 µg/l.

Conclusions
There is no rationale to continue GH therapy in growth promoting doses in the patients with isolated GHD after fulfilling the criteria of near-FH.

keywords:

Effectiveness, economical and safety aspects of growth hormone (GH) therapy in growth promoting doses in patients with isolated GH deficiency after the attainment of near-final height. Is there a need to modify the criteria of therapy withdrawal?

Joanna Smyczyńska 1 , Maciej Hilczer 2 , Andrzej Lewinski 2, 3 , Urszula Smyczyńska 4 , Renata Stawerska 2, 5

growth hormone deficiency, recombinant growth hormone, insulin-like growth factor-1, treatment efficacy, final height

Joanna Smyczyńska

¹

,

Maciej Hilczer

²

,

Andrzej Lewinski

^{2, 3}

,

Urszula Smyczyńska

⁴

,

Renata Stawerska

^{2, 5}