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Individualized GH treatment gives improved growth but not higher insulin nor IGF1 compared to standard GH dose after 2 years of catch-up growth

Paper i proceeding
Författare Ralph Decker
Kerstin Albertsson-Wikland
Berit Kriström
Jovanna Dahlgren
Publicerad i Hormone Research
Volym 68
Nummer/häfte Supplement Issue 1
Sidor 153
ISBN 3-8055-8327-3
Publiceringsår 2007
Publicerad vid Institutionen för kliniska vetenskaper
Sidor 153
Språk en
Ämnesord individualized GH treatment
Ämneskategorier Klinisk farmakologi

Sammanfattning

Weight-based approaches for ‘standard’ GH dosing result in dramatic variability in height outcome and IGF-1 levels. In a recent study we showed that growth response variability can be reduced by individualized GH dosing guided by the individual responsiveness estimated by our prediction model. The hypothesis was that despite many individuals needed higher GH doses, the individualized GH regimen would not give higher levels of metabolic variables compared to the group of children receiving standard treatment. We performed an open, prospective, randomized, multicentre trial in 128 prepubertal short children diagnosed as GHD or ISS, for a 2 yr catch-up growth period, with two treatment regimens providing the same mean GH dose a) individualized GH dose, ranging 17-100 µg/kg/day (n=87) and b) standard GH dose: 43 µg/kg/day (n=41). The set goal for treatment effect was to reach midparental height (MPH) SDS after 2 yrs of GH treatment. This goal was reached for a higher proportion of children treated with the individualized dose (p<0.01). Despite this there were no differences between the individual and the standard dose group concerning the mean and variances of Δinsulin, Δleptin, ΔIGF1(SDS), ΔIGF-BP3(SDS) and ΔIGF1/IGF-BP3(SDS). Δ is calculated as the difference between the value at 2 yrs and at the start of treatment. Moreover there were no differences between the groups regarding the mean or the range of these variables at 2 yrs of treatment. It can be concluded that despite a much broader range in GH dose, which comprised a maximum dose of more than 200% of the standard dose, the variability of the metabolic parameters during treatment within the groups and the absolute levels reached at 2 yrs were the same in the two groups. In fact a better growth response in relation to MPH(SDS) was achieved without a difference in metabolic variables between the groups. Individual dosing is preferable in GH treatment.

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