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Efficacy of intermittent therapy in growth hormone-deficient children

Bougnères P. Efficacy of intermittent therapy in growth hormone-deficient children. Eur J Endocrinol 1994;130:459–62. ISSN 0804–4643

Eighty-six growth hormone-deficient children treated with extractive growth hormone were transferred to recombinant growth hormone (rGH): 57 children were transferred directly to rGH, but 29 experienced a 9.7 ± 1-month pause in growth hormone administration. The retrospective analysis of growth from 1 year before to 1 year after initiation of rGH showed that the interruption of growth hormone administration did not modify the final height gain. During the 2 years, children with continuous therapy gained 12.2 ± 0.5 cm with a cumulative growth hormone dose of 43 ± 3 U/kg, while those who paused gained 12.1 ±0.3 cm with a cumulative growth hormone dose of only 24 ± 2 U/kg (p < 0.0005). As expected, during the year preceding the onset of rGH, the children who paused gained less height than those treated continuously, but grew more rapidly during the first year of rGH administration. This was due to an important re-acceleration of growth rate at re-initiation of therapy after the pause. Our observation suggests that regimens of discontinuous rGH administration could be as efficient as continuous treatment. If confirmed in prospective randomized trials, this could have important consequences for improving the clinical efficiency of a given dose of rGH, as well as for the patient's comfort, secondary effects and cost of therapy.

Pierre Bougnères, Service d'Endocrinologie Pédiatrique, Hôpital Saint Vincent de Paul, 82 avenue DenfertRochereau, 75014 Paris, France