title: Growth hormone regimens in Australia: analysis of the first 3 years of treatment for idiopathic growth hormone deficiency and idiopathic short stature.
abstract: OBJECTIVE
  To investigate response to growth hormone (GH) in the first, second and third years of treatment for all idiopathic GH-deficient (GHD) and idiopathic short stature (ISS) patients in Australia.
  
  
  BACKGROUND
  Eligibility for subsidized GH treatment in Australia is determined on auxological criteria for the indication of Short Stature and Slow Growth (SSSG), which includes ISS (SSSG-ISS). The biochemical GHD (BGHD, peak GH < 10 mU/l) and SSSG indications are treated similarly: starting dose of 4·5 mg/m(2)/week with provision for incremental dosing. Some ISS patients were specifically diagnosed with familial short stature (SSSG-FSS).
  
  
  METHODS
  Responses for each year of treatment for BGHD, SSSG-ISS and SSSG-FSS cohorts were compared in relation to influencing variables and with international benchmarks. The effect of incremental dosing was assessed.
  
  
  METHODS
  Australian BGHD, SSSG-ISS and SSSG-FSS patients who had completed 1, 2, or 3 years of treatment and were currently receiving GH.
  
  
  METHODS
  Growth hormone dose, change in height-standard deviation score (ΔSDS) and growth velocity (GV).
  
  
  RESULTS
  First-year response was 2-3 times greater than that in subsequent years: ΔSDS(1st year) = 0·92, 0·50 and 0·46 for BGHD, SSSG-ISS and SSSG-FSS, respectively. Responses were similar to international reports and inversely related to age at commencement of GH. First-year GV-for-age for BGHD patients was similar to international standards for idiopathic GHD. However, girls had an inferior response to boys when treatment commenced at <6 years of age. First-year GV-for-age for SSSG-ISS/FSS patients was less than ISS standards. Dose increments attenuated the first- to second-year decline in response to BGHD but marginally improved the responses for SSSG-ISS/FSS.
  
  
  CONCLUSIONS
  The Australian auxology-based GH programme produces comparable responses to international programmes. A lower starting dose is offset by the initiation of treatment at younger ages. Incremental dosing does not appear optimal. A first-year dose of 6·4-6·9 mg/m(2)/week for GHD and 8·9 mg/m(2)/week for ISS with early commencement of GH treatment may be most efficacious.
authors.affiliation: The Children's Nutrition Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Herston, Qld, Australia. i.hughes@uq.edu.au
authors.forename: Ian P
authors.initials: IP
authors.lastname: Hughes
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Choong
authors.forename: Geoff
authors.initials: G
authors.lastname: Ambler
authors.forename: Wayne
authors.initials: W
authors.lastname: Cutfield
authors.forename: Paul
authors.initials: P
authors.lastname: Hofman
authors.forename: Chris T
authors.initials: CT
authors.lastname: Cowell
authors.forename: George
authors.initials: G
authors.lastname: Werther
authors.forename: Andrew
authors.initials: A
authors.lastname: Cotterill
authors.forename: Peter S W
authors.initials: PS
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004392:Dwarfism / Q000188:drug therapy* / Q000453:epidemiology; D061345:Early Medical Intervention / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000188:drug therapy* / Q000453:epidemiology; D020249:Hormone Replacement Therapy / Q000379:methods; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone