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Combination therapy may boost height for girls with central precocious puberty
Chinese girls diagnosed with central precocious puberty achieved greater gains in total height when treated with combination gonadotropin-releasing hormone analogues, or GnRHa, plus recombinant growth hormone therapy, or rhGH, with low predicted adult height and greater bone age predicting greater success with treatment, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“GnRHa has been used clinically for central precocious puberty treatment to restore genetic growth potential for over 40 years because it prevents premature bone maturation and pubertal development,” Junfen Fu, MD, of the Children’s Hospital of Zhejiang University School of Medicine in Hangzhou, China, and colleagues wrote. “However, to the best of our knowledge, a large-scale multicenter study has not yet been performed on the long-term effects of GnRHa alone or GnRHa plus rhGH on the final height of girls with central precocious puberty/early and fast puberty. Additionally, the effect of the GnRHa treatment on adult height has been controversial.”
In a retrospective study, Fu and colleagues reviewed medical records from 448 Chinese girls diagnosed with central precocious puberty at a mean age of 8 years who received treatment with GnRHa alone (n = 276), combined GnRHa and rhGH treatment (n = 118) or no treatment (n = 54). Researchers followed participants from 1998 to 2017, until they reached their final adult height. Main outcomes were final adult height, target height and predictive adult height.
The researchers observed varying height gains across the three treatment groups, with mean gains of 9.51 cm, 8.07 cm and 6.44 cm, respectively, among girls who received combined treatment, GnRHa alone and no treatment (P < .05).
For genetic height gains, girls who received GnRHa treatment achieved a mean increase of 2 cm, whereas girls in the combined treatment group achieved a mean increase of 4 cm. Controls reached their target height, which was lower than observed in the two treatment groups.
In regression models designed to explore factors that could influence 5-cm or greater height gains, researchers found that girls with more advanced bone age; a larger difference between baseline predictive adult height and target height; a smaller predictive adult height, calculated height based on bone age, or height age per bone age ratio; and more significant height loss were more likely to benefit from treatment.
“Notably, our study identified that the patients who received the combined GnRHa and rhGH treatment gained more height, with a higher percentage of these patients achieving 5 cm height gains, compared with patients who received GnRHa treatment alone or no treatment,” the researchers wrote. “However, not all of the patients who received combined therapy achieved satisfactory height gains. Meanwhile, the cost for combination treatment was very expensive, and the treatment was not yet covered by health insurance in China.”
The researchers noted that the therapy may be beneficial for girls with central precocious puberty with a low predicted adult height and a greater degree of bone age. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.