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Observational Study
. 2017 Nov;177(5):421-429.
doi: 10.1530/EJE-16-1024. Epub 2017 Aug 5.

Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet® International Outcome Study

Michel Polak  1 , Jo Blair  2 , Primoz Kotnik  3 , Effie Pournara  4 , Birgitte Tønnes Pedersen  5 , Tilman R Rohrer  6
Affiliations
Observational Study

Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet® International Outcome Study

Michel Polak et al. Eur J Endocrinol. 2017 Nov.

Abstract

Objective: To investigate the effect of age at growth hormone (GH) treatment start on near adult height (NAH) in children with isolated GH deficiency (GHD).

Design: NordiNet® International Outcome Study (IOS) (Nbib960128), a non-interventional, multicentre study, evaluates the long-term effectiveness and safety of Norditropin® (somatropin) (Novo Nordisk A/S) in the real-life clinical setting.

Methods: Patients (n = 172) treated to NAH (height at ≥18 years, or height velocity <2 cm/year at ≥16 (boys) or ≥15 (girls) years) were grouped by age (years) at treatment start (early (girls, <8; boys, <9), intermediate (girls, 8-10; boys, 9-11) or late (girls, >10; boys, >11)) and GHD severity (<3 ng/mL or 3 to ≤10 ng/mL). Multiple regression analysis was used to evaluate the effect of age at treatment start (as a categorical and continuous variable) on NAH standard deviation score (SDS).

Results: Age at treatment start had a marked effect on NAH SDS; NAH SDS achieved by patients starting treatment early (n = 40 (boys, 70.0%); least squares mean (standard error) -0.76 (0.14)) exceeded that achieved by those starting later (intermediate, n = 42 (boys, 57.1%); -1.14 (0.15); late, n = 90 (boys, 68.9%); -1.21 (0.10)). Multiple regression analysis showed a significant association between NAH SDS and age at treatment start (P < 0.0242), baseline height SDS (HSDS) (P < 0.0001), target HSDS (P < 0.0001), and GHD severity (P = 0.0012). Most (78.5%) patients achieved a normal NAH irrespective of age at treatment start.

Conclusions: Early initiation of GH treatment in children with isolated GHD improves their chance of achieving their genetic height potential.

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Figures

Figure 1
Figure 1
Estimated NAH SDS by early (girls aged <8 years; boys aged <9 years), intermediate (girls aged 8–10 years; boys aged 9–11 years) and late (girls aged >10 years; boys aged >11 years) age group at GH treatment start. Data are LS means (95% CI) corrected for baseline HSDS, average GH dose, target HSDS, GH severity and mid-parental height. CI, confidence interval; GH, growth hormone; HSDS, height standard deviation score; LS, least squares; NAH, near adult height; SDS, standard deviation score.
Figure 2
Figure 2
Estimated change in HSDS from baseline to NAH by early (girls aged <8 years; boys aged <9 years), intermediate (girls aged 8–10 years; boys aged 9–11 years) and late (girls aged >10 years; boys aged >11 years) age group at GH treatment start. Data are LS means (95% CI) corrected for baseline HSDS, average GH dose, target HSDS, GH severity and mid-parental height. CI, confidence interval; GH, growth hormone; HSDS, height standard deviation score; ΔHSDS, change in height standard deviation score from baseline to NAH; LS, least squares; NAH, near adult height.
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References

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