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No adverse metabolic changes seen in older adults discontinuing GH therapy
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Discontinuing recombinant human growth hormone therapy in routine clinical practice does not cause significant metabolic changes in older adults, study findings show.
However, patients younger than 60 years may experience small but significant metabolic and bone changes, according to researchers.
“[Recombinant human GH] replacement in adult patients with [GH] deficiency is discontinued in clinical practice for a variety of reasons, but the long-term effects have not been documented,” Natasha M. Appelman-Dijkstra, MD, PhD, of the Center for Bone Quality at Leiden University Medical Center, the Netherlands, told Endocrine Today. “In this study, we critically evaluated the long-term (3 years) metabolic effects of [recombinant human GH] discontinuation in adult [GH-deficient] patients who had discontinued [recombinant human GH] replacement for at least 12 months.”
Natasha M. Appleman-Dijkstra
In a cohort study and systematic review, researchers analyzed data from 64 patients with GH deficiency who discontinued recombinant human GH (rhGH) for at least 12 months for any reason (mean age, 60 years; mean duration of rhGH treatment, 8.7 years; mean period of treatment discontinuation, 3.7 years). Researchers assessed body weight, BMI, bone turnover markers, parathyroid hormone, vitamin D levels, glucose, lipid profile, bone mineral density, bone mineral content, fat percentage (via DXA scans) and fracture data at baseline and 1, 2 and 3 years. Researchers also analyzed eight studies involving discontinuation of GH therapy (three randomized controlled trials; five cohort studies that included 166 patients) with follow-up between 6 and 18 months.
Patients who discontinued rhGH therapy experienced a mean increase in fat percentage from 31.5% to 33.8% (P = .003); glucose, total and LDL cholesterol levels did not change. In patients younger than 60 years, researchers observed an increase in HDL (P = .042) and a decrease in femoral neck BMD and bone turnover markers (P = .001).
“Our study did not show obvious adverse metabolic changes in the long term, besides a small increase in fat mass and a significant decrease in bone turnover markers during the first year after discontinuation,” Appelman-Dijkstra said. “When the results, however, were stratified for age (younger or older than 60 years), small but significant changes were also observed in BMI, HDL cholesterol and femoral neck BMD only in patients younger than 60 years but not in patients older than 60 years.
“This implicates that in advanced age, discontinuation of rhGH replacement could be considered as [GH] declines while aging,” Appelman-Dijkstra said. – by Regina Schaffer
For more information:
Natasha M. Appelman-Dij k stra, MD, PhD, can be reached at the Center for Bone Quality at Leiden University Medical Center, C07-Q-044, Albinusdreef 2, P.O. Box 9600 2300 RC Leiden, the Netherlands; email: N.M.Appelman-Dijkstra@lumc.nl.
Disclosure: One researcher reports receiving unrestricted grants from Ipsen and Pfizer. Appelman-Dijkstra reports no relevant financial disclosures.
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