title: GH therapy in adult GH deficiency: a review of treatment schedules and the evidence for low starting doses.
abstract: Recombinant human GH has been licensed for use in adult patients with GH deficiency (GHD) for over 15 years. Early weight- and surface area-based dosing regimens were effective but resulted in supraphysiological levels of IGF1 and increased incidence of side effects. Current practice has moved towards individualised regimens, starting with low GH doses and gradually titrating the dose according to the level of serum IGF1 to achieve an optimal dose. Here we present the evidence supporting the dosing recommendations of current guidelines and consider factors affecting dose responsiveness and parameters of treatment response. The published data discussed here lend support for the use of low GH dosing regimens in adult GHD. The range of doses defined as 'low dose' in the studies discussed here (∼1-4  mg/week) is in accordance with those recommended in current guidelines and encompasses the dose range recommended by product labels.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, c.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Gasco
authors.forename: Flavia
authors.initials: F
authors.lastname: Prodam
authors.forename: Silvia
authors.initials: S
authors.lastname: Grottoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Marzullo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Longobardi
authors.forename: Ezio
authors.initials: E
authors.lastname: Ghigo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Aimaretti
mesh_terms: D000328:Adult; D000367:Age Factors; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D009765:Obesity / Q000150:complications; D057285:Precision Medicine; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012727:Sex Characteristics
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I