Growth Hormone Treatment for Growth Failure in Pediatric Patients with Crohn's Disease

Abstract

Objective-We determined the impact of human growth hormone (GH) injections on growth velocity in growth impaired children with Crohn's Disease (CD). Study design-Ten children and adolescents (12.6±4.5 years; 6 male) with CD and poor height growth were treated with open label recombinant GH 0.043 mg/kg/day SQ for one year. Patients were retrospectively matched with untreated patients (3 comparisons per case) by race, age, sex, and baseline height. Primary endpoint was height velocity; secondary endpoints were disease activity, body composition, and bone density by DEXA scan. Results-Mean height velocity in GH-treated patients increased by 5.33±3.40 (mean ± SD) cm/yr during the year of GH compared with 0.96±3.52 cm/yr in the comparison group (p=0.03). Height Z score increased in the treated group by 0.76±0.38 compared with 0.16±0.40 in the comparison group (p<0.01), and weight Z score increased 0.81±0.89 compared with 0.00±0.57 (p<0.01). Bone density revealed an increase of the lumbar spine Z score by 0.31±0.33 (p=0.03 vs baseline). Conclusions-GH treatment increases height velocity and potentially enhances bone mineralization in children with CD. A randomized controlled trial in a large cohort of children is required to determine the ultimate impact of GH treatment.

Impact of Disease and Treatments on Growth and Puberty of Pediatric Patients with Inflammatory Bowel Disease

“…Although a preliminary study suggested a beneficial effect of recombinant human GH (rhGH) treatment on disease activity in 37 adults with CD [108], these results were not confirmed afterwards [109]. As rhGH treatment appears to exert no effect on disease activity, it has no place in the first-line treatment strategies of IBD patients.…”

“…However, this trial included a very small number of subjects and the results are controversial. While in some studies [109,111,112] height velocity, bone mineral density and body composition were improved, no significant improvement of nutritional status could be shown in others [113,114]. Mauras et al [111] described favorable changes in body composition and linear growth in 10 glucocorticoid-dependent IBD children treated with high-dose rhGH for 4 months, suggesting that rhGH therapy could counteract the inhibitory effect of glucocorticoids.…”

Effects of Recombinant Human Growth Hormone in Children with Crohn’s Disease on the Muscle-Bone Unit: A Preliminary Study

“…In another study of 10 children with CD treated with 12 months of rhGH (0.043 mg/kg/day), DXA LS BMD SDS adjusted for age increased by +0.31 SD [3]. However, the need to adjust DXA BMD and body composition data for size is now well recognized and addressed in our current study.…”

“…In accordance with an anabolic effect of GH, previous studies of recombinant human growth hormone (rhGH) therapy in children with chronic inflammation such as juvenile arthritis showed that, in addition to an increase in height, significant improvements in bone and muscle area were observed [2]. The effects of rhGH on the muscle-bone unit in CD has rarely been studied [3, 4]. A recent study in mice with colitis showed that deletion of the suppressor of cytokine signalling 2, a negative regulator of GH signalling, may be protective against the bone loss associated with inflammation [5].…”

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

“…Few studies have tried to answer this question. A small case control study has shown short-term (up to 1 year) therapeutic efficacy of rhGH in improving linear growth in children with CD standard maintenance therapy [135]. In contrast, a small randomized controlled trial by Calenda et al [136] failed to reveal any difference in growth parameters between children treated or untreated with rhGH.…”