Growth hormone regimens in Australia: analysis of the first three years of treatment for Idiopathic Growth Hormone Deficiency and Idiopathic Short Stature

Hughes, Ian P., Harris, Mark, Choong, Catherine S., Ambler, Geoff, Cutfield, Wayne, Hofman, Paul, Cowell, Chris T., Werther, George, Cotterill, Andrew, Davies, Peter S.W. and on behalf of the Australasian Paediatric Endocrine Group (APEG) (2012) Growth hormone regimens in Australia: analysis of the first three years of treatment for Idiopathic Growth Hormone Deficiency and Idiopathic Short Stature. Clinical Endocrinology, 77 1: 62-71. doi:10.1111/j.1365-2265.2011.04230.x

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Author Hughes, Ian P.
Harris, Mark
Choong, Catherine S.
Ambler, Geoff
Cutfield, Wayne
Hofman, Paul
Cowell, Chris T.
Werther, George
Cotterill, Andrew
Davies, Peter S.W.
on behalf of the Australasian Paediatric Endocrine Group (APEG)
Total Author Count Override 10
Title Growth hormone regimens in Australia: analysis of the first three years of treatment for Idiopathic Growth Hormone Deficiency and Idiopathic Short Stature
Journal name Clinical Endocrinology   Check publisher's open access policy
ISSN 0300-0664
1365-2265
Publication date 2012-07
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/j.1365-2265.2011.04230.x
Volume 77
Issue 1
Start page 62
End page 71
Total pages 33
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Formatted abstract Objective: 
To investigate response to growth hormone (GH) in the 1(st) , 2(nd) and 3(rd) years of treatment for all idiopathic GH deficient (GHD) and idiopathic short stature (ISS) patients in Australia.

Context:

Eligibility for subsidised GH treatment in Australia is determined on auxological criteria for the indication of Short Stature and Slow Growth (SSSG) which includes ISS (SSSG-ISS). The biochemical GHD (BGHD, peak GH<10mU/L) and SSSG indications are treated similarly: starting dose of 4.5mg/m(2) /week with provision for incremental dosing. Some ISS patients were specifically diagnosed with familial short stature (SSSG-FSS).

Design:
Responses for each year of treatment for BGHD, SSSG-ISS, and SSSG-FSS cohorts were compared in relation to influencing variables and with international benchmarks. The effect of incremental dosing was assessed.

Patients:
Australian BGHD, SSSG-ISS, and SSSG-FSS patients who had completed one, two, or three years of treatment and were currently receiving GH.

Measurements:
GH dose, change in height standard deviation score (ΔSDS), and growth velocity (GV).

Results: 
First year response was two to three times greater than that in subsequent years: ΔSDS(1st Year) =0.92, 0.50, and 0.46 for BGHD, SSSG-ISS, and SSSG-FSS respectively. Responses were similar to international reports and inversely related to age at commencement of GH. First year GV-for-age for BGHD patients was similar to international standards for idiopathic GHD. However, girls had an inferior response to boys when treatment commenced at less than 6 years of age. First year GV-for-age for SSSG-ISS/FSS patients was less than ISS standards. Dose increments attenuated the 1(st) -to-2(nd) year decline in response for BGHD but marginally improved responses for SSSG-ISS/FSS.

Conclusions: 
The Australian auxology based GH program produces comparable responses to international programs. A lower starting dose is offset by initiation of treatment at younger ages. Incremental dosing does not appear optimal. A first year dose of 6.4-6.9mg/m(2) /week for GHD and 8.9mg/m(2) /week for ISS with early commencement of GH treatment may be most efficacious.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Wed, 04 Apr 2012, 11:53:00 EST by Ms Lynette Adams on behalf of School of Medicine