CEDIE   05498
CENTRO DE INVESTIGACIONES ENDOCRINOLOGICAS "DR. CESAR BERGADA"
Unidad Ejecutora - UE
congresos y reuniones científicas
Título:
Prospective evaluation of Serum IGF-1 in GHD and SGA children under RHGH:Titration strategy for optimizing RHGH therapy
Autor/es:
DEBORA BRASLAVSKY; MARIA EUGENIA RODRIGUEZ; MARIA GABRIELA ROPELATO; MARIA GABRIELA BALLERINI; HORACIO DOMENÉ; IGNACIO BERGADÁ; ANA KESELMAN; HECTOR JASPER
Lugar:
Washington
Reunión:
Congreso; 10th International Joint Meeting of Pediatric Endocrinology; 2017
Institución organizadora:
The global community of pediatric endocrinology
Resumen:
Objectives: Elevated serum IGF-I are frequently found in children throughout rhGH therapy. Whether these sustained elevated serum levels expose them to develop greater long term adverse events (AE) remains controversial. Therefore, rhGH doses titration is nowadays recommended. Aim: To determine IGF-I in children on rhGH, evaluate the proportion of those who need to titrate (T) and their impact on efficacy.Methods: Prospective interventional study including prepubertal patients with growth hormone deficiency (GHD) and born small for gestational age (SGA) without catch up growth, naïve of rhGH therapy. Conventional weight based dosing of rhGH was indicated (GHD 0.21 ± 0.04 mg/kg/w; SGA 0.32 ± 0.04 mg/kg/w). IGF-I and IGFBP-3 were determined basally and every 3 months (IMMULITE 2000, Siemens). rhGH dose titration was conducted (10% diminished) when IGF-I was above +2 SDS in two consecutive controls. Efficacy was evaluated as Δ height gain.Results: Forty eight patients were enrolled (35 boys) aged 7.21 ± 2.86 years; 22 GHD and 26 SGA. Three patients were excluded (2 non-compliant, 1 serious AE probably not related to rhGH). Basal IGF-I, IGFBP-3 and IGF-I/IGFBP-3 molar ratio (mean ± SDS) were in GHD -3.02 ± 2.81, -2.15 ± 1.02, -0.8 ± 0.17 respectively; in SGA -0.55 ± 0.73, -0.62 ± 0.88, -0.22 ± 0.65, respectively. After 2 years the proportion of patients that required rhGH dose titration was 57% in GHD and 48% in SGA. The time of occurrence of the event (need to titrate) was similar for GHD (median 12 months) compared to SGA (median 9 months), p 0.14. Δ Height (mean ± SDS) was in GHD T 1.37 ± 0.71 vs GHD non-T 1.57 ± 0.82 (p 0.61) and in SGA T 0.95 ± 0.57 vs SGA non-T 1.23 ± 0.38, (p 0.18).Conclusions: Significant proportion of children have elevated IGF-I concentrations throughout conventional rhGH weight based dose. In our study a titration strategy does not appear to affect efficacy based on 2 years of height gain, leading to a physiological circulating IGF-I under treatment aiming towards a more safety approach.