Growth hormone prescribing and initial BMI SDS: Increased biochemical adverse effects and costs in obese children without additional gain in height

Hawcutt, DB ORCID: 0000-0002-8120-6507, Bellis, J, Price, V, Povall, A, Newland, P, Richardson, P, Peak, M ORCID: 0000-0003-1909-3211 and Blair, J (2017) Growth hormone prescribing and initial BMI SDS: Increased biochemical adverse effects and costs in obese children without additional gain in height. PLoS One, 12 (7). e0181567-.

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Abstract

BACKGROUND: Recombinant human growth hormone (rhGH) treatment in children is usually prescribed using actual body weight. This may result in inappropriately high doses in obese children. METHODS: Retrospective audit of all paediatric patients treated with rhGH 2010-14 at a tertiary paediatric hospital in the UK. Change in height SDS and IGF-I SDS during the first year of treatment was stratified by initial BMI SDS in a mixed cohort, and a subgroup of GH deficient (GHD) patients. Alternative doses for those BMI SDS ≥2.0 (Obese) were calculated using BSA, IBW and LBW. RESULTS: 354 patients (133 female) received rhGH, including 213 (60.2%) with GHD. Obesity was present in 40 patients (11.3%) of the unselected cohort, and 32 (15.0%) of the GHD cohort. For GHD patients, gain in height SDS was directly related to BMI SDS, except in obese patients (p<0.05). For both the entire cohort, and GHD patients only, IGF-1 SDS was significantly higher in obese patients (p<0.0001 for both groups). Cross sectional data identified 265 children receiving rhGH, 81 (30.5%) with a BMI-SDS ≥1.75. Alternate prescribing strategies for rhGH prescribing in obese patients suggest a saving of 27% - 38% annually. CONCLUSIONS: Gain in IGF-I SDS is greater in obese children, and is likely to be related to relatively higher doses of rhGH. Additional gain in height was not achieved at the higher doses administered to obese children. Alternative dosing strategies in the obese patient population should be examined in rigorous clinical trials.

Item Type:	Article
Uncontrolled Keywords:	Humans, Obesity, Growth Hormone, Recombinant Proteins, Body Mass Index, Body Height, Treatment Outcome, Retrospective Studies, Cross-Sectional Studies, Dose-Response Relationship, Drug, Child, Hospitals, Pediatric, Health Care Costs, Female, Male, Tertiary Care Centers, United Kingdom
Depositing User:	Symplectic Admin
Date Deposited:	18 Jul 2017 08:43
Last Modified:	19 Jan 2023 06:59
DOI:	10.1371/journal.pone.0181567
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3008530