Sermorelin: a review of its use in the diagnosis and treatment of children with idiopathic growth hormone deficiency.
Sermorelin, a 29 amino acid analogue of human growth hormone-releasing hormone (GHRH), is the shortest synthetic peptide with full biological activity of GHRH. Intravenous and subcutaneous sermorelin specifically stimulate growth hormone secretion from the anterior pituitary. Hormone responses to intravenous sermorelin 1 microg/kg bodyweight appear to be a rapid and relatively specific test for the diagnosis of growth hormone deficiency. False positive growth hormone responses are observed in fewer children without growth hormone deficiency after sermorelin than after other provocative tests. Adult data indicate that the combination of intravenous sermorelin and arginine is a more specific test and this merits evaluation in children with growth hormone deficiency. However, normal growth hormone responses to intravenous sermorelin cannot exclude growth hormone deficiency due to a hypothalamic deficit: subnormal growth hormone response to other provocative tests is needed to confirm the presence of disease in these patients. Limited data indicate that once daily subcutaneous sermorelin 30 microg/kg bodyweight given at bedtime is effective in treating some prepubertal children with idiopathic growth hormone deficiency. Significant increases in height velocity were sustained during 12 months' treatment with sermorelin and data in a few children suggest the effect is maintained for 36 months of continued treatment. Sermorelin induced catch-up growth in the majority of growth hormone-deficient children. Slow growing, shorter children with delayed bone and height age appear to have a good response to treatment with sermorelin. The effect of long term treatment with once daily subcutaneous sermorelin 30 microg/kg bodyweight on final adult height is yet to be determined. The effects of the recommended dosage of sermorelin have not been directly compared with those of somatropin. However, increases in height velocity from baseline values with subcutaneous sermorelin 30 microg/kg bodyweight per day, given as continuous infusion or as 3 divided doses, were less than those in children receiving once daily subcutaneous somatropin 30 microg/kg bodyweight. Intravenous single dose and repeated once daily subcutaneous doses of sermorelin are well tolerated. Transient facial flushing and pain at injection site were the most commonly reported adverse events.


CONCLUSIONS
Sermorelin is a well tolerated analogue of GHRH which is suitable for use as a provocative test of growth hormone deficiency when given as a single intravenous 1 microg/kg bodyweight dose in conjunction with conventional tests. Limited data suggest that once daily subcutaneous sermorelin 30 microg/kg bodyweight is effective in promoting growth in some prepubertal children with idiopathic growth hormone deficiency.
Prakash
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Adis International Limited, Auckland, New Zealand.
Goa
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KL