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GH dose reduction maintains normal prepubertal height velocity after initial catch up growth in short children

Nyhet: 2018-10-31

Decker R, Albertsson-Wikland K, Kriström B, Halldin M, Gustafsson J, Nilsson NO, Dahlgren J. GH dose reduction maintains normal prepubertal height velocity after initial catch up growth in short children. J Clin Endocrinol Metab. 2018. Epub 2018/10/20.

Abstract
Context:
GH responsiveness guides GH dosing during the catch-up growth (CUG) period; however, little is known regarding GH dosing during the prepubertal maintenance treatment period.
Objective:
To evaluate if standard deviation score (SDS) channel parallel growth with normal height velocity can be maintained following CUG by reducing GH dose by 50% in children receiving doses individualized based on estimated GH-responsiveness during the catch-up period.
Design:
and settings: Prepubertal children (n=98; 72 boys) receiving GH during CUG (GH-deficient (n=33); non-GH-deficient (n=65)), were randomized after 2-3 years to either a 50% reduced individualized (GHRID; n=27; 20 boys) or unchanged individualized dose (GHUID; n=38; 27 boys). Another 33 children (25 boys) continued on a standard weight-based dose, 43 µg/kg/day (GHFIX).
Main Outcome Measures:
The primary endpoint was the proportion of children with ΔheightSDS within ±0.3 at 1 year after GH-dose reduction, versus two control groups: GHUID and GHFIX. The hypothesis was that heightSDS could be maintained within ±0.3 with a reduced individualized GH dose.
Results:
For the intention-to-treat population at 1 year, 85% of the GHRIDgroup maintained ΔheightSDS within ±0.3 versus 41% in the GHUIDgroup, p=0.0055 and 48% in the GHFIXgroup, p=0.0047. ΔIGF-ISDS in the GHRIDgroup was (mean±SD) -0.75±1.0 at 3 months, p=0.003 and at 1 year -0.72±1.2, compared to the GHUIDgroup 0.15±1.2, p=0.005, and for the GHFIXgroup 0.05±1.0, p=0.02.
Conclusions:
Channel parallel growth, i.e. normal height velocity, and IGFSDS levels within ±2 were maintained after completed CUG using a 50% lower individualized dose than used during the CUG period.
 

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