Growth Hormone Treatment (GHT) of Adult Patients with Growth Hormone Deficiency for up to 4 Years: Results from the ANSWER ProgramŽ

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 130-162-Neuroendocrinology
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-151
Murray B Gordon*1, Richard A Levy2, Robert Z Gut3 and John A Germak3
1Allegheny Gen Hosp, Pittsburgh, PA, 2Rush-Presbyterian-St Luke's, Chicago, IL, 3Novo Nordisk Inc, Princeton, NJ
Background: Adult patients with growth hormone deficiency (AGHD) were enrolled in the American Norditropin Studies: Web-Enabled Research (ANSWER Program®/NovoNet®) program at the discretion of participating physicians. This analysis evaluated the use of GH stimulation tests (GHST) among AGHD patients, the GH dosing pattern in a real-world clinic setting, and the outcome of GHT over 4 years.  

Methods: Isolated GHD (IGHD) was diagnosed if the peak GH with GHST was <5 ng/mL; multiple pituitary hormone deficiency (MPHD) patients had to have at least one other pituitary hormone deficiency besides GHD. As of September, 2012 data from 468 patients (IGHD: 214, 46%; MPHD: 254, 54%) were included in the analysis. Outcome measures included changes in body weight (BW), body mass index (BMI), and IGF-I levels. The frequency and type of GHST were analyzed.

Results: Enrolled patients were typical of an AGHD population (275F/193M, age 48.0±13.7 yrs, BMI 32.4±7.1 kg/m2, IGF-I standard deviation score [SDS] -0.5±1.6). In 334 IGHD and MPHD patients who had at least one GHST, arginine (arg)+ l-dopa (91) was the most commonly used test (all were performed prior to 2010). Glucagon (84) was the second, followed by arg (59), insulin tolerance test (25), arg+GH releasing hormone (GHRH) (20), and arg+clonidine (20). Glucagon GHST accounted for 49% of all tests done in the past year. Cross-sectional analysis showed that mean IGF-I SDS increased over time (IGHD: –0.7±1.3 at baseline, 0.9±0.7 at Y4; MPHD: –0.4±1.8 at baseline, 0.6±1.2 at Y4). BW and BMI both decreased from baseline in IGHD patients (significant only at Y3: -5.2±16.4 kg for BW, P=0.0428; -1.9±6.3 for BMI, P=0.0496). BW and BMI did not significantly change over 4 years in MPHD patients. The median GH dose at baseline (mg/day) was higher for MPHD than IGHD patients, especially for younger MPHD patients (18-35 age group: 0.31 for IGHD, 0.60 for MPHD; 35-60 age group: 0.30 for IGHD, 0.42 for MPHD; 60 and above group: 0.29 for IGHD, 0.35 for MPHD).

Conclusions:  Glucagon has become the most frequently used GHST in recent years, which reflects current guidelines recommending its use and the discontinuation of GHRH in the US. Mean IGF-I SDS increased during GHT. Median GH dose was higher in younger MPHD patients, consistent with some younger patients receiving treatment during the transition phase from childhood GHD. Longer-term data in a larger population are needed to further assess potential effects of GH on BW and BMI.

Disclosure: MBG: Principal Investigator, Novo Nordisk, Advisory Group Member, Novo Nordisk. RAL: Principal Investigator, Novo Nordisk, Advisory Group Member, Novo Nordisk. RZG: Employee, Novo Nordisk. JAG: Employee, Novo Nordisk.

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Novo Nordisk, Inc.