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

Journal article
Authors Ralph Decker
Kerstin Albertsson-Wikland
Berit Kriström
Maria Halldin
Jan Gustafsson
Nils-Östen Nilsson
Jovanna Dahlgren
Published in The Journal of clinical endocrinology and metabolism
Volume 104
Issue 3
Pages 835-844
ISSN 1945-7197
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Physiology
Institute of Clinical Sciences, Department of Pediatrics
Institute of Clinical Sciences
Pages 835-844
Language en
Links dx.doi.org/10.1210/jc.2018-01006
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Individual treatment Prediction model of growth Children Maintenance growth
Subject categories Pediatrics, Endocrinology and Diabetes

Abstract

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.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.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).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.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.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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