Genotropin (somatropin, rbe) & Patient Transition

Treatment in young adults and adolescents

Continued growth hormone (GH) treatment can have benefits beyond final height 1-11

Not all adolescent patients will need to continue GH therapy after reaching final height. However, some adult patients with growth hormone deficiency (GHD) may see benefits by continuing GH therapy beyond final height: 12

  • Proven maturation of body composition

Continuing GH therapy after final height increases lean body mass and decreases fat mass 2-4

  • Increase in bone mass and density

Continuing GH therapy induces a significant progression towards peak bone mass 5,6

Continuation of Genotropin (somatropin) therapy beyond final height helps ensure that childhood-onset GHD patients achieve full somatic development 1-11

Current Guidelines for Patient Transition to Adult Treatment

Children with GH deficiency should be treated as outlined in the NICE Technology Appraisal Guidance 188.13

When linear growth has been achieved with a growth rate < 2 cm/year, GH treatment should be stopped for 2–3 months, and then GH status should be re-assessed.

As outlined in the NICE Technology Appraisal Guidance TA6414 GH treatment at adult doses should be re-started only in those satisfying the biochemical criteria for severe GH deficiency (defined as a peak GH response of less than 9 mU/litre (3 ng/ml) during an insulin tolerance test or a cross-validated GH threshold in an equivalent test), and continued until adult peak bone mass has been achieved (normally around 25 years of age).

After adult peak bone mass has been achieved, the decision to continue growth hormone treatment should be based on all the specified criteria for adult growth hormone replacement therapy .

Support Materials for Patients

Pfizer has developed booklets to support young adults transitioning to adult care.

Please visit our Helpline and Support page for further information.

References

  1. Clayton, P., Gleeson, H., Monson, J., Popovic, V., Shalet, S.M. and Christiansen, J.S., 2007. Growth hormone replacement throughout life: insights into age-related responses to treatment. Growth Hormone & IGF Research17(5), pp.369-382.
  2. Vahl, N., Juul, A., Jørgensen, J.O., Ørskov, H., Skakkebæk, N.E. and Christiansen, J.S., 2000. Continuation of growth hormone (GH) replacement in GH-deficient patients during transition from childhood to adulthood: a two-year placebo-controlled study. The Journal of Clinical Endocrinology & Metabolism85(5), pp.1874-1881.
  3. Attanasio, A.F., Shavrikova, E., Blum, W.F., Cromer, M., Child, C.J., Paskova, M., Lebl, J., Chipman, J.J., Hypopituitary Developmental Outcome Study Group and Shalet, S.M., 2004. Continued growth hormone (GH) treatment after final height is necessary to complete somatic development in childhood-onset GH-deficient patients. The Journal of Clinical Endocrinology & Metabolism89(10), pp.4857-4862.
  4. Carroll, P.V., Christ the members of Growth Hormone Research Society Scientific Committee, E.R., Bengtsson, B.A., Carlsson, L., Christiansen, J.S., Clemmons, D., Hintz, R., Ho, K., Laron, Z., Sizonenko, P. and Sonksen, P.H., 1998. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. The Journal of Clinical Endocrinology & Metabolism83(2), pp.382-395.
  5. Drake, W.M., Carroll, P.V., Maher, K.T., Metcalfe, K.A., Camacho-Hubner, C., Shaw, N.J., Dunger, D.B., Cheetham, T.D., Savage, M.O. and Monson, J.P., 2003. The effect of cessation of growth hormone (GH) therapy on bone mineral accretion in GH-deficient adolescents at the completion of linear growth. The Journal of Clinical Endocrinology & Metabolism88(4), pp.1658-1663.
  6. Shalet, S.M., Shavrikova, E., Cromer, M., Child, C.J., Keller, E., Zapletalová, J., Moshang, T., Blum, W.F., Chipman, J.J., Quigley, C.A. and Attanasio, A.F., 2003. Effect of growth hormone (GH) treatment on bone in postpubertal GH-deficient patients: a 2-year randomized, controlled, dose-ranging study. The Journal of Clinical Endocrinology & Metabolism88(9), pp.4124-4129.
  7. Underwood, L.E., Attie, K.M., Baptista, J. and Genentech Collaborative Study Group, 2003. Growth hormone (GH) dose-response in young adults with childhood-onset GH deficiency: a two-year, multicenter, multiple-dose, placebo-controlled study. The Journal of Clinical Endocrinology & Metabolism88(11), pp.5273-5280.
  8. Johannsson, G. and Ohlsson, C., 1998. 3 Growth hormone therapy and fracture risk in the growth hormone-deficient adult. Bailliere's clinical endocrinology and metabolism12(2), pp.233-250.
  9. Nørrelund, H., Vahl, N., Juul, A., Møller, N., Alberti, K.G.M.M., Skakkebæk, N.E., Christiansen, J.S. and Jørgensen, J.O.L., 2000. Continuation of growth hormone (GH) therapy in GH-deficient patients during transition from childhood to adulthood: impact on insulin sensitivity and substrate metabolism. The Journal of Clinical Endocrinology & Metabolism85(5), pp.1912-1917.
  10. Fors, H., Bjarnason, R., Wirén, L., AlbertssonWikland, K., Bosaeus, I., Bengtsson, B.Å. and Johannsson, G., 2001. Currently used growthpromoting treatment of children results in normal bone mass and density. A prospective trial of discontinuing growth hormone treatment in adolescents. Clinical endocrinology55(5), pp.617-624.
  11. Mauras, N., Pescovitz, O.H., Allada, V., Messig, M., Wajnrajch, M.P. and Lippe, B., 2005. Limited efficacy of growth hormone (GH) during transition of GH-deficient patients from adolescence to adulthood: a phase III multicenter, double-blind, randomized two-year trial. The Journal of Clinical Endocrinology & Metabolism90(7), pp.3946-3955.
  12. Thomas, J.D. and Monson, J.P., 2009. Adult GH deficiency throughout lifetime. European Journal of Endocrinology161(suppl_1), pp.S97-S106.
  13. NICE Guideline [TA188]. Human growth hormone (somatropin) for the treatment of growth failure in children. Available here. Last accessed August 2020
  14. NICE Guideline [TA64]. Human growth hormone (somatropin) in adults with growth hormone deficiency. Available here. Last accessed August 2020

 

PP-GEN-GBR-0784. August 2020