title: Recombinant growth hormone therapy in children with short stature in Kuwait: a cross-sectional study of use and treatment outcomes.
abstract: BACKGROUND
  Recombinant Growth hormone (rGH) therapy is approved in many countries for treatment of short stature in a number of childhood diagnoses. Despite the increasing body of international literature on rGH use, there is paucity of data on rGH use in Kuwait and the broader Middle-East which share unique ethnic and socio-cultural backgrounds. This study aimed to describe the pattern of use and treatment outcomes of rGH therapy in Kuwait.
  
  
  METHODS
  This is a cross-sectional retrospective review of children treated with rGH in the Department of Pediatrics, in a major hospital in Kuwait between December 2013 and December 2014. Data were extracted using standard data extraction form and the response to rGH therapy was defined as a gain of ≥ 0.3 standard deviation score (SDS) of height per year.
  
  
  RESULTS
  A total of 60 children were treated with rGH in the center. Their Median (Interquartile) age at rGH initiation was 9.0 (6.2, 10.7) years. The most common indications for rGH therapy were Growth Hormone Deficiency (GHD) 23 (38.3 %), Idiopathic Short Stature (ISS) 12 (20.0 %) and Small for Gestational Age (SGA) 9 (15.0 %). After excluding patients with TS, no significant differences were found in gender of those who received rGH therapy in all indications combined or in each group (p ≥ 0.40). At 1-year follow-up, children in all groups had median height SDS change of ≥ 0.3 SDS except for children with ISS. Age at rGH initiation was negatively associated with 1-year treatment response, Adjusted odds ratio (AOR) 0.56 (95 % CI: 0.04-1.49); p = 0.011).
  
  
  CONCLUSIONS
  GHD is the most common indication of rGH therapy. All indications except for ISS showed significant 1-year treatment response to therapy. Treatment outcomes in patients with ISS should be further investigated in Kuwait. Younger age at initiation of rGH therapy was independently associated with significant response to therapy suggesting the importance of identifying children with short stature and prompt initiation of rGH therapy.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait. d.alabdulrazzaq@hsc.edu.kw.
authors.forename: Dalia
authors.initials: D
authors.lastname: Al-Abdulrazzaq
authors.affiliation: Department of Community Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait. altaiar@hsc.edu.kw.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Taiar
authors.affiliation: Department of Pediatrics, Mubarak Al-Kabeer Hospital, Ministry of Health, Safat, Kuwait. eternity2alex@yahoo.com.
authors.forename: Kholoud
authors.initials: K
authors.lastname: Hassan
authors.affiliation: Department of Pediatrics, Mubarak Al-Kabeer Hospital, Ministry of Health, Safat, Kuwait. ewdln@icloud.com.
authors.forename: Iman
authors.initials: I
authors.lastname: Al-Basari
mesh_terms: D002648:Child; D002657:Child Development / Q000187:drug effects*; D003430:Cross-Sectional Studies; D004392:Dwarfism / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D007730:Kuwait; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone