THREE YEARS RESULTS OF TWO DOSE-REGIMENS OF GROWTH HORMONE (GH) IN PREPUBERTAl CHILDREN WITH IDIOPATHIC INTRA-UTERINE GROWTH RETARDATION (IUGR)

Abstract

We previously reported (ESPE 90) that GH treatment (SC, 6 d/w for 18 m) in 95 short IUGR non-GH-deficient prebubertal children (age 8.0 ± 0.2 yrs) increased height velocity in a dose dependent manner. We now report the results in 81 children GH-treated and measured during 3 years. They were at first randomized in 2 groups : D1 (n = 39) treated with 0.4 IU/kg/w of GH and D2 (n = 42) with 1.2 IU/kg/w. After 2 years, among D1 patients GH dose was increased to D2 in 24 (D1D2) and unchanged in 15 (D1D1). The mean height SDS for age presented in the figure below. The total height gain significantly differs in D2 from D1D1 and D1D2 (p ≤ 0.0002). Mean advances (± SEM) in bone age over 36 months were : 41.1 ± 3.6 (D1D1), 41.0 ± 2.8 (D1D2) and 46.4 ± 2.2 (D2). Pubertal stage 2 (Tanner) was reached in 15/50 M and 15/31 F during 1st yr (5 D1, 2 D2), 2nd yr (5 D1, 5 D2) or 3d yr (2 D1D1, 2 D1D2, 9D2). Over the 3 years treatment, serious adverse events occurred in 5/95 children : 1 1C hypertension (related to brain germinoma, GH discontinued), 1 Grand Mal seizure (epilepsy history), 2 localized s. (I neonatal anoxia, I related to brain cavernoma), I Petit Mal s. CONCLUSIONS : 1) The waning effect observed after the first year of GH treatment appears more pronounced for D1 than D2; 2) a slight catch up growth is possible in the 3rd year by increasing GH dose; 3) the bone age increase in D2, although non significant versus D1, may reduce the dose-dependent benefit of GH treatment on final height.