Long-term Mortality after Growth Hormone Treatment in Childhood
A French Study on the Effects of Growth Hormone Deficiency Treatment
The Safety and Appropriateness of Growth Hormone Treatments in Europe (SAGhE) is a study looking at the long-term effects on the health of patients who were treated with growth hormone (GH) in childhood. It looks specifically at children who had treatment with recombinant GH in France, and it evaluates the long-term mortality of those children.
The results of the study were published online January 11, 2012; the article also appeared in the February 2012 edition of the Journal of Clinical Endocrinology & Metabolism. The article is “Long-Term Mortality after Recombinant Growth Hormone Treatment for Isolated Growth Hormone Deficiency or Childhood Short Statue: Preliminary Report of the French SAGhE Study.”
The population-based cohort study involved 6,928 children with idiopathic isolated growth hormone deficiency (n = 5,162), neurosecretory dysfunction (n = 534), idiopathic short stature (n = 871), or born short for gestational age (n = 335). Those children started GH treatment between 1985 and 1996. In September 2009, follow-up data on vitals were available for 94.7% of those patients.
The researchers looked at the following main outcome measures:
- All-cause mortality
- Cause-specific mortality
It was seen that all-cause mortality was increased in those patients treated with GH—standardized mortality ratio (SMR) 1.33, confidence interval (CI) 95%; 1.08-1.64. The researchers also did a multivariate analysis adjusted for height, and in that, they found that the use of growth hormone doses > 50 μg/kg was associated with mortality rates when using external and internal references (SMR 2.94, CI 95%; 1.22-7.07, hazard ratio 2.79, CI 95%; 1.14-6.82).
However, all type cancer-related mortality was not increased with GH treatment, but bone tumor-related mortality was increased (SMR 5.00, CI 95%; 1.01-14.63).
There was an increase in mortality related to circulatory system disease (SMR 3.07, CI 95%; 1.40-5.83) or related to subarachnoid or intracerebral hemorrhage (SMR 6.66, CI 95%; 1.79-17.05).
At the end of this preliminary report on SAGhE, the researchers concluded that mortality rates were increased in patients treated with recombinant growth hormone in childhood. This increase was particularly seen in those patients who received the highest doses. Because of these findings, the need for more long-term studies on mortality and morbidity in patients treated with growth hormone is clear.