Normal Height Velocity Maintained With Reduced Growth Hormone Dose

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Considering GH treatment is given to short children for extended periods of time, the ultimate goal is to use the lowest effective dose for the patient after achieving complete catch-up growth.
Considering GH treatment is given to short children for extended periods of time, the ultimate goal is to use the lowest effective dose for the patient after achieving complete catch-up growth.

According to study results published in The Journal of Endocrinology & Metabolism, normal height velocity can be maintained in prepubertal children during the catch-up growth period by reducing growth hormone (GH) dosage by 50%.

To determine how a GH dose reduction during the catch-up growth period affected channel parallel growth with normal height velocity, researchers randomly assigned 98 prepubertal children (average age, 8.5 years) to receive an unchanged individualized GH dose (n = 38), half of their usual individualized dose (n = 27), or a standard weight-based dose of 43 μg/kg/day (n = 33). Of the total population, 33 participants had GH deficiency and 65 did not have GH deficiency during the catch-up growth period.

The researchers' primary outcome was to determine the proportion of intervention participants achieving channel parallel growth (ie, normal height velocity, defined as a ± 0.3 change in height standard deviation score). At the 1-year mark, 85% of the reduced-dose group in the intention-to-treat population maintained normal height velocity compared with 41% (P =.006) in the unchanged dose group and 48% in the weight-based dose group (P =.005).

There were no significant differences between groups for attained mean insulin-like growth factor 1 (IGF-1) standard deviation score at the start of the study or at 1-year follow-up. However, mean standard deviation score for IGF-1 in the reduced-dosage group decreased from 2.3 ± 1.3 at start to 1.5 ± 1.1 at 3 months (P =.002), compared with nonsignificant changes for the unchanged dose group and weight-based group.

The researchers noted several limitations to this study, including the arbitrary decision to reduce GH dosage by 50%.

Despite concluding that their primary goal was achieved, the researchers said, “such a dose reduction must be accompanied by close monitoring [of well-being] and metabolic markers as presently there is no method for estimation of individual GH-responsiveness during the maintenance treatment period before puberty.”

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Reference

Decker R, Albertsson-Wikland K, Kriström B, et al. GH dose reduction maintains normal prepubertal height velocity after initial catch up growth in short children [published online October 18, 2018]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-01006

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