Real-world data support combined GnRH analogue, GH therapy for added height gain in ISS

medwireNews: Data from clinical practice support the option of adding gonadotrophin-releasing hormone (GnRH) analogue to growth hormone (GH) therapy in some clinical situations to extend the treatment window and optimise final height in children with idiopathic short stature (ISS).

Liora Lazar (Schneider Children’s Medical Center of Israel, Petah Tikva) and co-researchers offered GnRH analogue treatment to two groups of children with ISS: prepubertal children already receiving GH who had “relatively early” puberty and pubertal children who had not previously received GH.

In “these challenging groups”, the addition of GnRH analogue was expected to reduce the epiphyseal maturation rate, thus extending the pubertal period and the time in which children may benefit from GH therapy.

As reported in The Journal of Clinical Endocrinology & Metabolism, the study participants comprised 192 children in total, of whom 126 were prepubertal and 66 were pubertal. All children received GH, in addition to which 31 prepubertal and 27 pubertal children were given a GnRH analogue for at least 1 year.

Children who received combination treatment had a significantly longer duration of puberty and significantly greater total pubertal growth than those who received GH alone. This was true for both boys and girls and irrespective of whether children were pubertal or prepubertal at treatment initiation.

However, treatment initiation prior to puberty was associated with a significantly greater gain of height standard deviation score (SDS) and a greater adult height SDS – per se and relative to predicted and target height.

Children who received GnRH analogue versus GH alone had, on average, a significantly taller final adult height relative to predicted height, and had an adult height that was taller than their target height.

They did not have a significantly taller adult height SDS per se, but the researchers stress that children in the prepubertal group were given GnRH analogue because of their “reduced height prognosis” relative to those given GH only, due to more advanced puberty and a younger age, and so “attainment of a comparable [adult height] can be considered a therapeutic success”.

The average height SDS at treatment initiation was approximately –2.5 in both groups, and final adult height SDSs ranged from around –1.0 to –0.5.

The researchers believe that the observed positive effects of combined treatment versus GH alone in these patient groups “justifies the addition of GnRH [analogue] to pubertal ISS patients with poor height prognosis, and the initiation of GH therapy in adolescents presenting in the endocrine clinic in mid-puberty because of ISS.”

However, they add that randomised trials are necessary to determine if additional GnRH analogue “might be superior to GH alone in the general ISS population.”

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

J Clin Endocrinol Metab 2019; doi:10.1210/jc.2019-00233
Martin Savage
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