Delays to growth hormone treatment initiation persist in Europe

Eleanor McDermid
J Ped Endocrinol Metab 2018; Advance online publication
01 April 2018

medwireNews: Analysis of data from the NordiNet® International Outcome Study highlights continued delays in treating children with growth hormone deficiency (GHD) and the use of suboptimal doses in patients with Turner syndrome (TS).

Researchers led by Michel Polak (Hôpital Universitaire Necker Enfants Malades, Paris, France), assessed data from more than 6000 patients given GH: 3974 because they had GHD; 1926 because they were born small for gestational age (SGA) and did not have spontaneous catch-up growth and 428 who had TS.

The average age at which children started treatment for GHD ranged from 8.2 to 11.2 years, depending on the country. Between 2006 and 2015, the age at treatment initiation decreased significantly in Germany and the Czech Republic, whereas it did not noticeably change in Switzerland, Serbia and Montenegro, and the UK, and appeared to increase in France.

The researchers describe the observed decreases as “relevant”, because they represent increased proportions of children starting treatment at an optimal young age, or at least before puberty.

“However, large proportions of children with GHD still started treatment late in all countries between 2013 and 2015”, they note.

In 2015, the proportion of children starting treatment late (girls >10 years; boys >11 years) ranged from 21.7% in the Czech Republic to 67.6% in Serbia and Montenegro; the proportions starting early (girls <8 years; boys <9 years) were 70.1% and 18.8%, in the same two countries.

“Early detection of abnormal growth and referral to a pediatric endocrinologist, so that the underlying cause(s) can be identified, are critical for appropriate treatment”, Polak and team write in the Journal of Pediatric Endocrinology and Metabolism.

There were similar treatment trends over time for patients born SGA, for whom treatment is recommended from age 4 years if catch-up growth has not occurred. The proportion of children who started treatment late ranged from 10.5% in the Czech Republic to 43.8% in Serbia and Montenegro. (Switzerland and the UK were not included in this analysis.)

There were too few TS patients in the analysis (again excluding Switzerland and the UK) for the researchers to draw conclusions about trends in age at treatment initiation. However, they did note that the average GH dose used decreased over time in all countries so that by 2015 these ranged from 36.5 μg/kg per day in Germany to 45.6 μg/kg per day in France. The average dose was below the recommended 45 μg/kg per day in most years for all countries except France.

Lastly, and in line with other studies, the researchers found that only around a third of patients with GHD were female, falling to a quarter in Switzerland.

They say their findings “emphasize the need for accurate growth monitoring during the healthcare maintenance of all children, particularly girls, to ensure appropriate referral and treatment.”

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