The influence of growth hormone (GH) substitution on patient-reported outcomes and cognitive functions in GH-deficient patients: a meta-analysis.
OBJECTIVE
The influence of growth hormone (GH) replacement on patient-reported outcomes (i.e., quality of life, health status and well-being) and cognitive functioning in GH-deficient adults is controversial.


METHODS
We carried out a meta-analysis of clinical trials concerning the influence of GH substitution on patient-reported outcomes and cognitive functions (studies were selected from 1985 to 2004). The results of individual studies were combined in a series of meta-analyses using a random effects model. Effects of GH replacement in GH-deficient adults were compared to baseline and/or placebo.


RESULTS
Fifteen studies on GH and patient-reported outcomes were included (830 patients, follow-up 3-50 months). Four of these studies also provided data on cognitive functions (85 patients, follow-up 6-12 months). Relative to baseline, GH treatment is found to have a large effect on patient-reported outcomes at 3 months, a medium effect at 6 months and a small effect at 12 months. With respect to the median treatment duration of 6 months placebo appears to be as effective as GH substitution. Cognitive functioning does not improve after 6 months of GH substitution, relative to baseline.


CONCLUSIONS
This meta-analysis provides no evidence that GH improves patient-reported outcomes in GH-deficient patients. As the amount of cognitive data was too limited to allow for comparisons with placebo, from the present meta-analysis no conclusions can be drawn with respect to the impact of GH treatment on cognition.
Arwert
L I
LI
Department of Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. l.arwert@vumc.nl
Deijen
J B
JB
Witlox
J
J
Drent
M L
ML
D000293:Adolescent; D000328:Adult; D000368:Aged; D003071:Cognition / Q000187:drug effects*; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D010919:Placebos; D011788:Quality of Life; D013002:Somatomedins / Q000378:metabolism; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D010919:Placebos; D013002:Somatomedins; D019382:Human Growth Hormone; D013006:Growth Hormone