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Linglart A, Coutant R, Polak M, Nicolino M. Long-acting growth hormone in the management of GHD in France. Arch Pediatr 2024; 31:357-364. [PMID: 39030125 DOI: 10.1016/j.arcped.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 07/21/2024]
Abstract
Approximately 10,000 children in France with growth hormone deficiency (GHD) are being administered daily recombinant human growth hormone (rhGH). Although this treatment has long proved efficient for restoring children's growth and metabolism, daily injections of rhGH have a few limitations, such as difficulties in terms of adherence to treatment, which may compromise growth during childhood but also metabolism in adulthood. In addition to the disease burden and besides the adherence hurdles, the obligations related to daily injection have a negative impact on the quality of life of patients and their families. The hypothesis that injections administered at intervals of 1 week, or even 1 month, could improve compliance, reduce treatment discontinuations, and optimize quality of life and therapeutic effectiveness has led to the emergence of new long-acting growth hormone (LAGH). Recent access to LAGHs (somatrogon MA) on the European and French market will likely be followed by a high demand from the families concerned and may raise questions on their effectiveness, safety, and practical use. Numerous practical and practice-related points are needed to guide prescribing physicians while many concerns are still left unresolved (treatment effectiveness or ineffectiveness endpoints, long-term effectiveness, etc.). These issues can only be addressed in the future by compiling registries and conducting long-term real-world studies.
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Affiliation(s)
- Agnès Linglart
- AP-HP, Paris Saclay University, INSERM U1185, Endocrinology and Diabetes for children, Reference Center for rare diseases of calcium and phosphate metabolism, OSCAR network, Platform of expertise for rare diseases of Paris Saclay Hospital, Bicêtre Paris Saclay Hospital, Le Kremlin-Bicêtre, France.
| | - Régis Coutant
- Service d'Endocrinologie et Diabétologie Pédiatrique, Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Centre de Référence (constitutif) des Maladies Rares de l'Hypophyse, FIRENDO network, CHU Angers, 49000 Angers, France
| | - Michel Polak
- Hôpital Universitaire Necker Enfants Malades, Pediatric Endocrinology, Gynecology and Diabetology, Imagine Institute, INSERM U1163, Cochin Institute, INSERM U1016, Centre de référence des pathologies endocriniennes rares de la croissance et du développement, FIRENDO network, Université de Paris Cité, Paris, France
| | - Marc Nicolino
- Hospices Civils de Lyon, Service d'Endocrinologie et Diabétologie Pédiatriques et Centre PRISIS, Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité, FIRENDO network, Hôpital Femme-Mère-Enfant 69500, Bron, France
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Adedeji A, Witt S, Innig F, Quitmann J. A comprehensive systematic review of health-related quality of life measures in short stature paediatric patients. Endocrine 2024:10.1007/s12020-024-03938-6. [PMID: 39017834 DOI: 10.1007/s12020-024-03938-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
This systematic review investigates Patient-reported Outcome Measures (PROMs) and Observed Reported Outcome Measures (ObsROMs) pertinent to assessing Health-Related Quality of Life (HRQoL) in short-stature paediatric patients, focusing on Achondroplasia (ACH), Growth Hormone Deficiency (GHD), Isolated Growth Hormone Deficiency (IGHD), and Small-for-Gestational-Age (SGA) diagnoses. Utilising rigorous selection criteria, 53 studies published from 1998 to 2023 were analysed, revealing a predominance of European-based research. Notably, the review elucidated the utilisation of disease-specific and generic HRQoL measures, showcasing the multifaceted nature of short-stature conditions and their impact across physical, emotional, and social domains. The Quality of Life in Short Stature Youth (QoLISSY), Paediatric Quality of Life Inventory (PedsQL), and KIDSCREEN emerged as frequently employed instruments, offering nuanced insights into HRQoL perceptions across diverse age demographics. Additionally, the review highlighted the adaptation of adult HRQoL measures for adolescent populations, signalling a need for age-appropriate assessment tools. Furthermore, integrating PROMs and ObsROMs in HRQoL assessment underscored a comprehensive approach, considering both subjective patient perspectives and observed outcomes. Future research directions encompass comprehensive search strategies, longitudinal studies with diverse populations, and the development of age-appropriate HRQoL assessment tools. In conclusion, this review emphasises the importance of comprehensive HRQoL assessment to address the diverse needs of short-stature paediatric patients effectively.
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Affiliation(s)
- Adekunle Adedeji
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany
- Department of Medical Psychology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany
- Department of Medical Psychology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Innig
- BKMF Federal Association for People of Short Stature and their Families (Bundesverband Kleinwüchsige Menschen und ihre Familien e.V.), BKMF, Hamburg, Germany
| | - Julia Quitmann
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany.
- Department of Medical Psychology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
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Loftus J, Quitmann J, Valluri SR. Health-related quality of life in pre-pubertal children with pediatric growth hormone deficiency: 12-month results from a phase 3 clinical trial of once-weekly somatrogon versus once-daily somatropin. Curr Med Res Opin 2024; 40:175-184. [PMID: 38053515 DOI: 10.1080/03007995.2023.2290623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Treatment of pediatric growth hormone deficiency (pGHD) with daily injection of recombinant human growth hormone (somatropin) aims to increase height velocity and improve health-related quality of life (HRQoL). The Quality of Life in Short Stature Youth (QoLISSY) questionnaire was administered in a phase 3 clinical trial that evaluated efficacy and safety of once-weekly somatrogon versus once-daily somatropin in children with pGHD (ClinicalTrials.gov no NCT02968004). METHODS Treatment-naïve prepubertal children with pGHD received once-weekly somatrogon or once-daily somatropin for 12 months. The QoLISSY core module (physical/social/emotional subscales) was administered at baseline and 12 months after treatment initiation. QoLISSY-Parent was completed by parents/caregivers of children <7 years old and some parents/caregivers of children ≥7 years old; children ≥7 years old self-completed QoLISSY-Child. RESULTS Baseline characteristics were similar between treatment groups (N = 117). Among children <7 years old, QoLISSY-Parent total and subscale scores showed similarly improved HRQoL at 12 months relative to baseline in both treatment groups. Self-reported QoLISSY-Child total and subscale scores in children ≥7 years old indicated HRQoL improvements at 12 months that were numerically better with somatrogon than somatropin (similar results with QoLISSY-Parent in this age group). At both time points, children reported better HRQoL than perceived by their parents/caregivers. CONCLUSION Treatment for 12 months with once-weekly somatrogon or once-daily somatropin resulted in comparable improvements in HRQoL among children with pGHD. Lower HRQoL perceived by parents/caregivers possibly reflect children's tendency to emphasize adaptation. These results suggest that evaluation of HRQoL could help support treatment decisions in children with pGHD treated with growth hormone.
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Takasawa K, Mabe H, Nagamatsu F, Amano N, Miyakawa Y, Sutani A, Kagawa R, Okada S, Tanahashi Y, Suzuki S, Hiroshima S, Nagasaki K, Dateki S, Takishima S, Takahashi I, Kashimada K. Growth Hormone Injection Log Analysis with Electronic Injection Device for Qualifying Adherence to Low-Irritant Formulation and Exploring Influential Factors on Adherence. Patient Prefer Adherence 2023; 17:1885-1894. [PMID: 37545653 PMCID: PMC10404042 DOI: 10.2147/ppa.s417142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Although the treatment success of long-term growth hormone therapy (GHT) is dependent on maintaining patients' adherence to treatment, marked variations in adherence levels among children with GHT (eg, 7-71% nonadherence) have been reported. Barriers to or promoters of GHT adherence have been discussed and investigated, and digital health technologies, such as electronic GH injection devices, may have the potential to assess adherence to GHT more accurately. Thus, we conducted a multicenter, retrospective cohort study using GH injection log analysis of an electronic GH device, GROWJECTOR®L, to qualify adherence and explore the factors influencing adherence. Methods This study enrolled 41 patients (median[range] age, 5.8[3.0 ~ 17.0] years) with short stature from nine Japanese medical institutions. The injection log data (12-48 weeks) were read by smartphones and collected into the data center through a cloud server. Results Although cumulative adherence rates remained higher than 95% throughout the observation period, five (12.2%) patients had low adherence (<85%). Subsequently, subgroup and logistic regression analyses for exploring factors affecting adherence revealed that self-selection of GH device and irregular injection schedule (ie, frequent injections after midnight) significantly affected adherence rate (p=0.034 and 0.048, respectively). In addition, higher rates of irregular injections significantly affected low adherence (median[range], 11.26[0.79 ~ 30.50]% vs 0.26[0.00 ~ 33.33]%, p = 0.029). Discussion Our study indicated that injection log analysis using an electronic GH device could detect irregular injection schedules due to a night owl or disturbance in lifetime rhythm affecting low adherence and had significant potential to encourage collaborative monitoring of adherence with healthcare providers and patients themselves/caregivers, along with growing autonomy and shared decision-making. Our study suggests the significance of narrative and personal approaches to adherence of patients with GHT and the usefulness of digital devices for such an approach and for removing various barriers to patient autonomy, leading to improvement and maintenance of adherence.
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Affiliation(s)
- Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyo Mabe
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Fusa Nagamatsu
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoko Amano
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Yuichi Miyakawa
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Akito Sutani
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Reiko Kagawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Tanahashi
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Shigeru Suzuki
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Shota Hiroshima
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sumito Dateki
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Ikuko Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Coutant R, Tauber M, Demaret B, Henocque R, Brault Y, Montestruc F, Chassany O, Polak M. Treatment burden, adherence, and quality of life in children with daily GH treatment in France. Endocr Connect 2023; 12:EC-22-0464. [PMID: 36866786 PMCID: PMC10083659 DOI: 10.1530/ec-22-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE The objective of this study was to describe in a real-life setting the treatment burden and adherence and quality of life (QOL) of children treated with daily injections of growth hormone and their relationship with treatment duration. DESIGN This non-interventional, multicenter, cross-sectional French study involved children aged 3-17 years treated with daily growth hormone injections. METHODS Based on a recent validated dyad questionnaire, the mean overall life interference total score (100 = most interference) was described, with treatment adherence and QOL, using the Quality of Life of Short Stature Youth questionnaire (100 = best). All analyses were performed according to treatment duration prior to inclusion. RESULTS Among the 275/277 analyzed children, 166 (60.4%) had only growth hormone deficiency (GHD). In the GHD group, the mean age was 11.7 ± 3.2 years; median treatment duration was 3.3 years (interquartile range 1.8-6.4). The mean overall life interference total score was 27.7 ± 20.7 (95% CI (24.2; 31.2)), with non-significant correlation with treatment duration (P = 0.1925). Treatment adherence was good (95.0% of children reported receiving >80% of planned injections over the last month); it slightly decreased with treatment duration (P = 0.0364). Children's overall QOL was good (81.5 ± 16.6 and 77.6 ± 18.7 according to children and parents, respectively), but subscores of the coping and treatment impact domains were <50. Similar results were observed in all patients independently of the condition requiring treatment. CONCLUSIONS This real-life French cohort confirms the treatment burden of daily growth hormone injections, as previously reported in an interventional study.
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Affiliation(s)
- Régis Coutant
- Department of Pediatric Endocrinology and Diabetology, Reference Center for Rare Pituiatry Diseases, University Hospital of Angers, Angers, France
- Correspondence should be addressed to R Coutant:
| | - Maithé Tauber
- Reference Center for the Prader-Willi syndrome and other rare obesities with feeding disorders (PRADORT), Children Hospital, CHU Toulouse, Toulouse, France
- Pediatric team of the Clinical Investigation Center 9302/INSERM, Hospital of Children, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse, France
| | - Béatrice Demaret
- GRANDIR - French Growth Disorders Association, Asnières-sur-Seine, France
| | | | | | | | - Olivier Chassany
- Health Economics Clinical Trial Unit (URC-ECO), Hospital of Hotel-Dieu, AP-HP, Paris, France
- Patient-Reported Outcomes Unit (PROQOL), UMR 1123, University Paris Cité, INSERM, Paris, France
| | - Michel Polak
- Hôpital Universitaire Necker Enfants Malades, Pediatric Endocrinology, Gynecology and Diabetology, Imagine Institute, INSERM U1163, Cochin Institute, INSERM U1016, Centre de référence des pathologies endocriniennes rares de la croissance et du développement, Université de Paris Cité, Paris, France
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Rodrígez JMR, Toda LI, López ID, Muñoz JB, Fresno LS, Hernández EF, de Arriba Muñoz A. Adult height and health-related quality of life in patients born small for gestational age treated with recombinant growth hormone. Sci Rep 2023; 13:3135. [PMID: 36823445 PMCID: PMC9950462 DOI: 10.1038/s41598-023-30281-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Health related quality of life (HRQoL) is a relevant result when assessing the course of different pathologies and the efficacy of their treatments. HRQoL has been studied previously on adults born small for gestational age (SGA), both in the general population and in patients who had received recombinant human growth hormone (rhGH) treatment, with disparate results. Our study included 50 adults who had received rhGH treatment for the SGA indication in 4 Spanish hospitals. Data have been gathered retrospectively from their clinical records, current weight and height were measured, and patients have been asked to fill out SF-36 and QoLAGHDA quality of life forms, and the Graffar test to evaluate their socio-economical status. Patient's adult height was - 1.2 ± 0.9 SD, lower than their target height of 1 ± 0.8 SD, but gaining 1.7 ± 1 SD from the beginning of the treatment. SF-36 test results showed lower scoring on Mental Health domains than on those related to Physical Health. No correlation was found between HRQoL results and final height, rhGH treatment duration or puberty. Correlation was indeed found between QoLAGHDA and several domains of SF-36, but QoLAGHDA detected fewer patients with low HRQoL than SF-36. Thus, it is concluded that SGA patient's follow-up should include a HRQoL, neuro-cognitive and psychiatric assessment in their transition to adult age. Adult SGA patients without catch up growth have impaired HRQoL, especially in mental health domains.
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Affiliation(s)
| | | | - Ignacio Díez López
- Pediatric Endocrinology Unit, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - Jordi Bosch Muñoz
- Pediatric Endocrinology Unit, Arnau de Vilanova Hospital, Lleida, Spain
| | | | | | - Antonio de Arriba Muñoz
- Pediatric Endocrinology Unit, Miguel Servet Hospital, Av Isabel La Católica 1-3, 50009, Zaragoza, Spain.
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Brod M, Rasmussen MH, Alolga S, Beck JF, Bushnell DM, Lee KW, Maniatis A. Psychometric Validation of the Growth Hormone Deficiency-Child Treatment Burden Measure (GHD-CTB) and the Growth Hormone Deficiency-Parent Treatment Burden Measure (GHD-PTB). PHARMACOECONOMICS - OPEN 2023; 7:121-138. [PMID: 36255609 PMCID: PMC9929004 DOI: 10.1007/s41669-022-00373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim was to evaluate the measurement properties of the Growth Hormone Deficiency-Child Treatment Burden Measure-Child (GHD-CTB-Child), a patient-reported outcome (PRO) for children aged 9 to < 13 years; the Growth Hormone Deficiency-Child Treatment Burden Measure-Observer (GHD-CTB-Observer), an observer-reported outcome (ObsRO) version completed by parents/guardians of children with growth hormone deficiency (GHD) aged 4 to < 9 years; and the Growth Hormone Deficiency-Parent Treatment Burden Measure (GHD-PTB), a PRO that assesses the treatment burden of parents/guardians living with children with GHD aged 4 to < 13 years. METHODS A non-interventional, multi-center, clinic-based study across 30 private practice and large institutional sites in the United States and the United Kingdom was conducted. The sample consisted of 145 pre-pubertal children aged 9 to < 13 years at enrollment with a physician confirmed GHD diagnosis as well as 98 parents/guardians of pre-pubertal younger children aged 4 to < 9 years at enrollment with a physician confirmed GHD diagnosis. The child sample consisted of 59 treatment-naïve children (no prior exposure to growth hormone [GH] therapy; were starting GH treatment at study start per standard of care) and 184 children already maintained on treatment for at least 6 months. At baseline, all study participants completed a paper validation battery including all measures needed to conduct the validation analyses. Follow-up assessments with children in the maintenance group and their caregiver/parent were conducted approximately 2 weeks post-baseline to evaluate test-retest reproducibility. To evaluate sensitivity to change and meaningful change thresholds, treatment-naïve participants in both child and parent/guardian populations were assessed within 1 week of report of minimal improvement between week 3 and week 11 and at week 12. Psychometric analyses were implemented following an a priori statistical analysis plan. RESULTS Factor analyses confirmed the a priori conceptual domains and Overall score for each measure (GHD-CTB-Child and GHD-CTB-Observer domains: Physical, Emotional Well-being, and Interference; GHD-PTB domains: Emotional Well-being and Interference). Internal consistency was acceptable for all measures (Cronbach's alpha > 0.70). Test-retest reliability was acceptable for the Physical, Emotional, and Overall domains of the GHD-CTB versions, and the Emotional and Overall domains of the GHD-PTB (intraclass correlation coefficient above 0.70). All but one of the convergent validity hypotheses for the GHD-CTB versions and all hypotheses for the GHD-PTB were proven (r > 0.40). Known-groups validity hypotheses were significant for length of time to administer the injections in the GHD-CTB versions (p < 0.001 for Physical, Emotional, and Overall, and p < 0.01 for Interference) and whether parents/guardians versus child gave the injections more often for the Emotional domain of the GHD-PTB (p < 0.05). Associated effect sizes ranged from -0.27 to -0.57 for GHD-CTB versions and from -0.74 to -0.69 for the GHD-PTB, indicating that the measures are sensitive to change. Anchor-based patient and parent/guardian ratings of severity suggest preliminary meaningful change thresholds (GHD-CTB: 6 points for Physical score, 9 for Emotional, and 6 for Interference; GHD-PTB: 10 points for Emotional and 6 for Interference scores). CONCLUSIONS The psychometric properties of the GHD-CTB-Child, GHD-CTB-Observer, and GHD-PTB support the validity of their use as PRO and ObsRO measures to capture the experiences associated with treatment burden for children with GHD and their parents/guardians in both clinical and research settings. The Clinicaltrials.gov registration number NCT02580032 was first posted October 20, 2015.
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Affiliation(s)
| | | | | | | | | | - Kai Wai Lee
- Novo Nordisk A/S, Søborg, Denmark
- Biopharmaceuticals R&D, AstraZeneca, Cambridge, UK
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Du Z, Yuan J, Wu Z, Chen Q, Liu X, Jia J. Circulating Exosomal circRNA_0063476 Impairs Expression of Markers of Bone Growth Via the miR-518c-3p/DDX6 Axis in ISS. Endocrinology 2022; 163:6668858. [PMID: 35974445 DOI: 10.1210/endocr/bqac138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Idiopathic short stature (ISS), a disorder of unknown cause, accounts for approximately 80% of the clinical diagnoses of children with short stature. Exosomal circular RNA in plasma has been implicated in various disease processes. However, the role of exosome-derived circRNA in ISS has not been elucidated yet. METHODS Plasma exosomes of ISS and normal children were cocultured with human chondrocytes. Microarray analysis and RT-PCR identified the differential expression of circRNA in exosomes between ISS and normal children. Hsa_circ_0063476 was upregulated or downregulated in human chondrocytes. Subsequently, overexpression rats of hsa_circ_0063476 was constructed via adenoviral vector to further validate the role of hsa_circ_0063476 on longitudinal bone growth via in vivo experiment. RESULTS The plasma exosome of ISS children suppressed the expression of markers of chondrocyte hypertrophy and endochondral ossification. Subsequently, upregulation of hsa_circ_0063476 in ISS exosome was identified. In vitro experiments demonstrated that chondrocyte proliferation, cell cycle and endochondral ossification were suppressed, and apoptosis was increased following hsa_circ_0063476 overexpression in human chondrocytes. Conversely, silencing hsa_circ_0063476 in human chondrocytes can show opposite outcomes. Our study further revealed hsa_circ_0063476 overexpression in vitro can enhance chondrocyte apoptosis and inhibit the expression of markers of chondrocyte proliferation and endochondral ossification via miR-518c-3p/DDX6 axis. Additionally, the rats with hsa_circ_0063476 overexpression showed a short stature phenotype. CONCLUSIONS The authors identified a novel pathogenesis in ISS that exosome-derived hsa_circ_0063476 retards the expression of markers of endochondral ossification and impairs longitudinal bone growth via miR-518c-3p/DDX6 axis, which may provide a unique therapeutic avenue for ISS.
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Affiliation(s)
- Zhi Du
- Departments of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Jinghong Yuan
- Departments of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Zhiwen Wu
- Departments of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qi Chen
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xijuan Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Jingyu Jia
- Departments of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
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Büyükkaragöz B, Soysal Acar AŞ, Ekim M, Bayrakçı US, Bülbül M, Çaltık Yılmaz A, Bakkaloğlu SA. Utility of continuous performance test (MOXO-CPT) in children with pre-dialysis chronic kidney disease, dialysis and kidney transplantation. J Nephrol 2022; 35:1873-1883. [DOI: 10.1007/s40620-022-01382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 10/16/2022]
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10
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Loftus J, Chen Y, Gupta A, Wajnrajch MP, Alvir JMJ, Silverman LA, Jhingran P, Kumar M, Prasad S. Suboptimal adherence to prescribed daily growth hormone regimen among medicaid beneficiaries in the United States. Curr Med Res Opin 2022; 38:917-925. [PMID: 35477409 DOI: 10.1080/03007995.2022.2070378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The objective of this retrospective cohort study was to describe the adherence and discontinuation patterns of somatropin over 3 years among children with pGHD insured by Medicaid across the United States. METHODS Eligible children were aged ≥3 and <16 years with Medicaid coverage, diagnosed with pGHD, and had ≥2 new prescriptions for somatropin between 1 July 2014 and 31 December 2018. Four non-exclusive patient cohorts were constructed (≥3, 12, 24, and 36 months of continuous enrollment after initial prescription). Suboptimal adherence was defined as medication possession ratio <0.80, and discontinuation as a gap of >60 days between somatropin fills. Logistic and proportional hazards regression methods were used to estimate odds of suboptimal adherence and time to discontinuation, respectively. RESULTS In the 12-month cohort (n = 3623), mean age was 10.5 ± 3.2 years, 70.8% were male, 44.4% White, 29.1% Hispanic, 7.1% Black, and 1.7% Asian. At months 12, 24, and 36, the proportion with suboptimal adherence was 40.9, 50.4, 54.4%, respectively, and 49.2% of patients with ≥3 months of follow-up discontinued therapy. At 12 months, lower age and race/ethnicity (Black vs. White referent) had greater odds of suboptimal adherence. Discontinuation was associated with Black (vs. White referent) race and geographic region. CONCLUSIONS Sociodemographic characteristics may be risk factors for suboptimal adherence and/or discontinuation of prescribed somatropin therapy. Improving GH regimen adherence among this at-risk population, and specifically among subgroups at highest risk, is warranted to improve clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Mahesh Kumar
- Clarify Health Solutions, San Francisco, CA, USA
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González Briceño LG, Kariyawasam D, Samara-Boustani D, Giani E, Beltrand J, Bolle S, Fresneau B, Puget S, Sainte-Rose C, Alapetite C, Pinto G, Piketty ML, Brabant S, Abbou S, Aerts I, Beccaria K, Bourgeois M, Roujeau T, Blauwblomme T, Di Rocco F, Thalassinos C, Pauwels C, Rigaud C, James S, Busiah K, Simon A, Bourdeaut F, Lemelle L, Guerrini-Rousseau L, Orbach D, Touraine P, Doz F, Dufour C, Grill J, Polak M. High Prevalence of Early Endocrine Disorders After Childhood Brain Tumors in a Large Cohort. J Clin Endocrinol Metab 2022; 107:e2156-e2166. [PMID: 34918112 DOI: 10.1210/clinem/dgab893] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Endocrine complications are common in pediatric brain tumor patients. OBJECTIVE We aimed to describe the endocrine follow-up of patients with primary brain tumors. METHODS This is a noninterventional observational study based on data collection from medical records of 221 patients followed at a Pediatric Endocrinology Department. RESULTS Median age at diagnosis was 6.7 years (range, 0-15.9), median follow-up 6.7 years (0.3-26.6), 48.9% female. Main tumor types were medulloblastoma (37.6%), craniopharyngioma (29.0%), and glioma (20.4%). By anatomic location, 48% were suprasellar (SS) and 52% non-suprasellar (NSS). Growth hormone deficiency (GHD) prevalence was similar in both groups (SS: 83.0%, NSS: 76.5%; P = 0.338), appearing at median 1.8 years (-0.8 to 12.4) after diagnosis; postradiotherapy GHD appeared median 1.6 years after radiotherapy (0.2-10.7). Hypothyroidism was more prevalent in SS (76.4%), than NSS (33.9%) (P < 0.001), as well as ACTH deficiency (SS: 69.8%, NSS: 6.1%; P < 0.001). Early puberty was similar in SS (16%) and NSS (12.2%). Hypogonadotropic hypogonadism was predominant in SS (63.1%) vs NSS (1.3%), P < 0.001, and postchemotherapy gonadal toxicity in NSS (29.6%) vs SS (2.8%), P < 0.001. Adult height was lower for NSS compared to target height (-1.0 SD, P < 0.0001) and to SS patients (P < 0.0001). Thyroid nodules were found in 13/45 patients (28.8%), including 4 cancers (4.8-11.5 years after radiotherapy). Last follow-up visit BMI was higher in both groups (P = 0.0001), and obesity incidence was higher for SS (46.2%) than NSS (17.4%). CONCLUSION We found a high incidence of early-onset endocrine disorders. An endocrine consultation and nutritional evaluation should be mandatory for all patients with a brain tumor, especially when the tumor is suprasellar or after hypothalamus/pituitary irradiation.
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Affiliation(s)
- Laura Gabriela González Briceño
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
- ESPE Fellowship - European Society for Paediatric Endocrinology
| | - Dulanjalee Kariyawasam
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Dinane Samara-Boustani
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Elisa Giani
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Jacques Beltrand
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
- Université de Paris, 75006 Paris, France
| | - Stéphanie Bolle
- Institut Gustave Roussy, Département de radiothérapie-oncologie, 94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
| | - Stéphanie Puget
- Université de Paris, 75006 Paris, France
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Christian Sainte-Rose
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Claire Alapetite
- Institut Curie, Radiation Oncology Department and Proton Center, 75005 Paris, France
| | - Graziella Pinto
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Marie-Liesse Piketty
- Hôpital Necker-Enfants Malades, Explorations Fonctionnelles, 75015 Paris, France
| | - Séverine Brabant
- Hôpital Necker-Enfants Malades, Explorations Fonctionnelles, 75015 Paris, France
| | - Samuel Abbou
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
| | - Isabelle Aerts
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Kevin Beccaria
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Marie Bourgeois
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Thomas Roujeau
- Hôpital Montpellier, Hôpital Gui de Chauliac, Unité de Neurochirurgie pédiatrique, 34295 Montpellier, France
| | - Thomas Blauwblomme
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | | | - Caroline Thalassinos
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Christian Pauwels
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Charlotte Rigaud
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
| | - Syril James
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Kanetee Busiah
- Lausanne University Hospital, Pediatric Endocrinology, Diabetology and Obesity Unit, Lausanne University, 1011 Lausanne, Switzerland
| | - Albane Simon
- Hôpital André Mignot - Centre Hospitalier de Versailles, Endocrinologie Pédiatrique, 78157 Le Chesnay, France
| | - Franck Bourdeaut
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Lauriane Lemelle
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Léa Guerrini-Rousseau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
- Team "Genomics and Oncogenesis of Pediatric Brain Tumors", INSERM U981, Gustave Roussy, University Paris Saclay, 94805 Villejuif, France
| | - Daniel Orbach
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
- PSL Research University, 75006 Paris, France
| | - Philippe Touraine
- Hôpital Universitaire La Pitié-Salpêtrière - APHP, Service Endocrinologie et médecine de la reproduction, Sorbonne Université Médecine, 75013 Paris, France
| | - François Doz
- Université de Paris, 75006 Paris, France
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Christelle Dufour
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
- Team "Genomics and Oncogenesis of Pediatric Brain Tumors", INSERM U981, Gustave Roussy, University Paris Saclay, 94805 Villejuif, France
| | - Jacques Grill
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
- Team "Genomics and Oncogenesis of Pediatric Brain Tumors", INSERM U981, Gustave Roussy, University Paris Saclay, 94805 Villejuif, France
| | - Michel Polak
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
- Université de Paris, 75006 Paris, France
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12
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Bamba V, Kanakatti Shankar R. Approach to the Patient: Safety of Growth Hormone Replacement in Children and Adolescents. J Clin Endocrinol Metab 2022; 107:847-861. [PMID: 34636896 DOI: 10.1210/clinem/dgab746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 02/07/2023]
Abstract
The use of recombinant human growth hormone (rhGH) in children and adolescents has expanded since its initial approval to treat patients with severe GH deficiency (GHD) in 1985. rhGH is now approved to treat several conditions associated with poor growth and short stature. Recent studies have raised concerns that treatment during childhood may affect morbidity and mortality in adulthood, with specific controversies over cancer risk and cerebrovascular events. We will review 3 common referrals to a pediatric endocrinology clinic, followed by a summary of short- and long-term effects of rhGH beyond height outcomes. Methods to mitigate risk will be reviewed. Finally, this information will be applied to each clinical case, highlighting differences in counseling and clinical outcomes. rhGH therapy has been used for more than 3 decades. Data are largely reassuring, yet we still have much to learn about pharmaceutical approaches to growth in children and the lifelong effect of treatment.
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Affiliation(s)
- Vaneeta Bamba
- The Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Roopa Kanakatti Shankar
- The George Washington University School of Medicine, Children's National Hospital, Washington, DC 20010, USA
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13
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Gonzalez-Briceño L, Viaud M, Polak M. Adherence and quality of life in children receiving rhGH treatment. Arch Pediatr 2022; 28:8S3-8S8. [PMID: 37870531 DOI: 10.1016/s0929-693x(22)00036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Short stature may have a major impact on quality of life (QoL), not only during adulthood but also during childhood. Treatment by growth hormone may induce improvement in QoL through height gain, as shown in recent articles, with an increase in general health-related and also height-specific QoL assessed by self-reports and parental reports. In a paper published by our team, we show altered general-health QoL in patients with very short stature (≤ -3 SD) and an improvement in general and height-specific scales in the complete population (≤ -2 SD) after one year of recombinant human growth hormone (rhGH) treatment, perceived both by children and their parents, with a moderate positive correlation with height gain. Adequate results in terms of height gain depend on different factors: the patient's age, underlying condition for which rhGH is prescribed and dose of rhGH treatment, among others. Daily injections may cause a significant burden for the child and family, and may alter adequate adherence to treatment. Identifying positive and negative factors in the patient and in the healthcare providers-patient team and encouraging a shared decision-making process are important for improving the patient's adherence to treatment. New long-acting forms of rhGH that will be available in the next few years may play an important part in improving treatment-related QoL and adherence to treatment. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- L Gonzalez-Briceño
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Paris, France.
| | - M Viaud
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Paris, France
| | - M Polak
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Paris, France; Université de Paris, France; Institut IMAGINE (affiliate), Paris, France
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Butler MG, Miller BS, Romano A, Ross J, Abuzzahab MJ, Backeljauw P, Bamba V, Bhangoo A, Mauras N, Geffner M. Genetic conditions of short stature: A review of three classic examples. Front Endocrinol (Lausanne) 2022; 13:1011960. [PMID: 36339399 PMCID: PMC9634554 DOI: 10.3389/fendo.2022.1011960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Noonan, Turner, and Prader-Willi syndromes are classical genetic disorders that are marked by short stature. Each disorder has been recognized for several decades and is backed by extensive published literature describing its features, genetic origins, and optimal treatment strategies. These disorders are accompanied by a multitude of comorbidities, including cardiovascular issues, endocrinopathies, and infertility. Diagnostic delays, syndrome-associated comorbidities, and inefficient communication among the members of a patient's health care team can affect a patient's well-being from birth through adulthood. Insufficient information is available to help patients and their multidisciplinary team of providers transition from pediatric to adult health care systems. The aim of this review is to summarize the clinical features and genetics associated with each syndrome, describe best practices for diagnosis and treatment, and emphasize the importance of multidisciplinary teams and appropriate care plans for the pediatric to adult health care transition.
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Affiliation(s)
- Merlin G. Butler
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Merlin G. Butler,
| | - Bradley S. Miller
- Pediatric Endocrinology, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, United States
| | - Alicia Romano
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Judith Ross
- Department of Pediatrics, Nemours Children’s Health, Wilmington, DE, United States
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Philippe Backeljauw
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Vaneeta Bamba
- Division of Endocrinology, Children’s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amrit Bhangoo
- Pediatric Endocrinology, Children's Health of Orange County (CHOC) Children’s Hospital, Orange, CA, United States
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children’s Health, Jacksonville, FL, United States
| | - Mitchell Geffner
- The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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15
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Wood CL, Page J, Foggin J, Guglieri M, Straub V, Cheetham TD. The impact of testosterone therapy on quality of life in adolescents with Duchenne muscular dystrophy. Neuromuscul Disord 2021; 31:1259-1265. [PMID: 34702655 PMCID: PMC8721209 DOI: 10.1016/j.nmd.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/19/2021] [Accepted: 09/21/2021] [Indexed: 11/04/2022]
Abstract
Testosterone therapy for pubertal induction was associated with improvements in QoL. Physical changes during puberty played an important role. Low self-esteem was also a prevailing theme. Parent-reported QoL scores were lower than patient-reports, consistent with other literature. Data from this study will provide a useful foundation for future work.
Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy in childhood. It is associated with progressive muscle function decline and premature death. Long-term oral glucocorticoid use slows muscle weakness but is associated with several side effects including delayed puberty. This study assessed the impact of a 2-year incremental intramuscular testosterone regimen on quality of life (QoL) in a cohort of 15 adolescents with DMD. The Pediatric Quality of Life Inventory (PedsQL) Neuromuscular module was used to assess QoL and was completed by parent-child dyads. Semi-structured interviews were carried out to understand patient views on testosterone therapy. QoL scores increased in 10 of the 15 participants during treatment, with a mean total PedsQL score of 74.6 pre-treatment v 80.2 post treatment (p = 0.04). This was supported by comments in the semi-structured interviews. Parent-reported PedsQL scores were lower than their child's post treatment (p = 0.007). Testosterone therapy for pubertal induction was associated with an improvement in QoL and the observed physical changes during puberty played an important role. Low self-esteem was also a prevailing theme. This data supports the inclusion of testosterone therapy for pubertal induction as a Standard of Care.
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Affiliation(s)
- C L Wood
- Translational and Clinical Research Institute, Newcastle University UK; Department of Paediatric Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust UK.
| | - J Page
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust UK
| | - J Foggin
- Department of Paediatric Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust UK
| | - M Guglieri
- Translational and Clinical Research Institute, Newcastle University UK; John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust UK
| | - V Straub
- Translational and Clinical Research Institute, Newcastle University UK; John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust UK
| | - T D Cheetham
- Translational and Clinical Research Institute, Newcastle University UK; Department of Paediatric Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust UK
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Constantinides C, Landis SH, Jarrett J, Quinn J, Ireland PJ. Quality of life, physical functioning, and psychosocial function among patients with achondroplasia : a targeted literature review. Disabil Rehabil 2021; 44:6166-6178. [PMID: 34403286 DOI: 10.1080/09638288.2021.1963853] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Achondroplasia (ACH) is the most common form of skeletal dysplasia, resulting in disproportionate short stature and medical complications. We review the literature on physical functioning, psychosocial function, and quality of life (QoL) in ACH individuals compared to average stature individuals or other short stature conditions. Studies that assess the association between these outcomes and height, limb length/lengthening surgery in ACH patients are also summarized. MATERIALS AND METHODS PubMed/MEDLINE and Embase were searched through April 2021. Study inclusion criteria were: (1) quantitative design; (2) study population consisting solely/mainly of ACH patients; (3) reports of physical functioning, psychosocial functioning, and/or QoL. Included studies were summarized separately for pediatric and adult populations. RESULTS Of 1664 records identified, 23 primary studies (sample size 8-437 participants) were included. Multiple tools were used across studies, including the generic PedsQL and SF-36 and height-specific QoLISSY. CONCLUSIONS The literature demonstrates that ACH patients experience limitations in physical functioning and poorer QoL outcomes compared to average stature people across the life span. This appeared to be at least in part due to disproportionate short stature. Future research to better characterize QoL in ACH patients will assist clinicians to better evaluate the effectiveness of management programs including novel interventions.IMPLICATIONS FOR REHABILITATIONPatients with achondroplasia experience limitations in physical functioning and poorer quality of life throughout their life course when compared to average statured individuals.Psychosocial issues are also heightened in adults with achondroplasia compared to average statured peers but are observed less frequently in children and adolescents with achondroplasia.The overall impact that limb lengthening has on physical functioning and QoL remains unclear, although there is some evidence that greater height or upper limb length may lead to an improvement in these parameters.Rehabilitation professionals should regularly assess physical functioning, psychosocial wellbeing, and quality of life in individuals with achondroplasia using condition-specific tools.
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Affiliation(s)
| | | | | | | | - Penelope J Ireland
- Children's Health Queensland Hospital & Health Service, Brisbane, Australia
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A Retrospective Analysis of Patients with Short Stature in Eastern China between 2013 and 2019. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6640026. [PMID: 33997034 PMCID: PMC8081605 DOI: 10.1155/2021/6640026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
Objective To identify the aetiology of growth and development diseases and assess the long-term effectiveness of recombinant human growth hormone (rhGH) therapy in a real-life clinical setting and provide better guidance in clinical strategy and decision making. Methods This retrospective study included 1145 children and adolescents with short stature admitted to the Department of Endocrinology, Affiliated Hospital of Jining Medical University, from January 2013 to December 2019, of whom 484 received rhGH treatment. The related anthropometrics and laboratory examinations were assessed in all participants. Results A total of 1145 children and adolescents with short stature aged 10.5 ± 3.3 years, including 740 boys and 405 girls, were analysed in this study. The number of children and adolescents with short stature gradually increased per year from 2013 to 2019. The mean pretreatment height standard deviation score (SDS) and insulin-like growth factor-1 SDS were −2.93 ± 1.05 and -1.01 (-1.83--0.16), respectively. The majority of the children (658, 57.47%) were prepubescent. In total, 484 subjects aged 10.6 ± 3.2 years received rhGH and were followed up, and among them, 292 children were treated for more than one year. As the treatment time increased, the children's height SDS gradually increased, and most of them attained a height SDS within the normal range. The mean height SDS in children who were treated for more than one year was −3.0 ± 1.0 at baseline and gradually increased to −0.8 ± 0.3 by year 6. The results were consistent across subgroups of different aetiologies of short stature. Conclusions Increasing attention has been given to the height of children during the period of 2013–2019 in eastern China. The present findings indicate that children with short stature need to be referred to a specialist centre to diagnose the cause of growth failure and that short children receiving rhGH therapy show a significant increase in height over time.
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Backeljauw P, Cappa M, Kiess W, Law L, Cookson C, Sert C, Whalen J, Dattani MT. Impact of short stature on quality of life: A systematic literature review. Growth Horm IGF Res 2021; 57-58:101392. [PMID: 33975197 DOI: 10.1016/j.ghir.2021.101392] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We sought to obtain a better understanding of the burden of short stature using a systematic literature review. METHODS Studies of the burden of short stature, of any cause in adults and children, were searched using Embase, MEDLINE and Cochrane databases in April 2020, capturing publications from 2008 onwards. Case series and populations with adult-onset growth hormone deficiency (GHD) were excluded. RESULTS Of 1684 publications identified, 41 studies (33 in children, 8 in adults) were included. All studies assessed human burden. Most study populations in children included short stature due to GHD, idiopathic short stature (ISS) and short stature after being born small for gestational age (SGA). In these populations, four studies showed that quality of life (QoL) in children with short stature was significantly worse than in children with normal stature. A significant association between QoL and short stature was observed in children with chronic kidney disease (CKD) (3 studies), achondroplasia (1 study) and transfusion-dependent β-thalassaemia (1 study), and in samples with mixed causes of short stature (3 studies). Three studies (one in GHD/ISS/SGA and two in CKD) found no significant association between short stature and QoL, and several studies did not report statistical significance. Approximately half of adult studies showed that QoL was reduced with short stature, and the other half showed no association. Two studies, one in adults with Prader-Willi syndrome and one in children with GHD, suggested a potential association between short stature and poorer cognitive outcomes. Three studies demonstrated an increased caregiver burden in parents of children with short stature. CONCLUSIONS Evidence suggests that, compared with those with normal stature, children and adults with short stature of any cause may experience poorer QoL. Further research could extend our understanding of the human burden in this field.
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Affiliation(s)
- Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Marco Cappa
- Bambino Gesù Children's Hospital, Rome, Italy
| | - Wieland Kiess
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Lisa Law
- Oxford PharmaGenesis, Oxford, UK
| | | | | | | | - Mehul T Dattani
- UCL Great Ormond Street Institute of Child Health, London, UK
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Nakamura-Takahashi A, Tanase T, Matsunaga S, Shintani S, Abe S, Nitahara-Kasahara Y, Watanabe A, Hirai Y, Okada T, Yamaguchi A, Kasahara M. High-Level Expression of Alkaline Phosphatase by Adeno-Associated Virus Vector Ameliorates Pathological Bone Structure in a Hypophosphatasia Mouse Model. Calcif Tissue Int 2020; 106:665-677. [PMID: 32076747 DOI: 10.1007/s00223-020-00676-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/09/2020] [Indexed: 01/01/2023]
Abstract
Hypophosphatasia (HPP) is a systemic skeletal disease caused by mutations in the gene encoding tissue-nonspecific alkaline phosphatase (TNALP). We recently reported that survival of HPP model mice can be prolonged using an adeno-associated virus (AAV) vector expressing bone-targeted TNALP with deca-aspartate at the C terminus (TNALP-D10); however, abnormal bone structure and hypomineralization remained in the treated mice. Here, to develop a more effective and clinically applicable approach, we assessed whether transfection with TNALP-D10 expressing virus vector at a higher dose than previously used would ameliorate bone structure defects. We constructed a self-complementary AAV8 vector expressing TNALP driven by the chicken beta-actin (CBA) promoter (scAAV8-CB-TNALP-D10). The vector was injected into both quadriceps femoris muscles of newborn HPP mice at a dose of 4.5 × 1012 vector genome (v.g.)/body, resulting in 20 U/mL of serum ALP activity. The 4.5 × 1012 v.g./body-treated HPP mice grew normally and displayed improved bone structure at the knee joints in X-ray images. Micro-CT analysis showed normal trabecular bone structure and mineralization. The mechanical properties of the femur were also recovered. Histological analysis of the femurs demonstrated that ALP replacement levels were sufficient to promote normal, growth plate cartilage arrangement. These results suggest that AAV vector-mediated high-dose TNALP-D10 therapy is a promising option for improving the quality of life (QOL) of patients with the infantile form of HPP.
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Affiliation(s)
- Aki Nakamura-Takahashi
- Department of Pharmacology, Tokyo Dental College, 2-9-18, Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan.
| | - Toshiki Tanase
- Department of Pediatric Dentistry, Tokyo Dental College, Tokyo, Japan
| | - Satoru Matsunaga
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Seikou Shintani
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Department of Pediatric Dentistry, Tokyo Dental College, Tokyo, Japan
| | - Shinichi Abe
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Yuko Nitahara-Kasahara
- Department of Molecular Therapy, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Atsushi Watanabe
- Division of Clinical Genetics, Kanazawa University Hospital, Ishikawa, Japan
| | - Yukihiko Hirai
- Division of Molecular and Medical Genetics, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Takashi Okada
- Division of Molecular and Medical Genetics, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Akira Yamaguchi
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Oral Health Science Center, Tokyo Dental College, Tokyo, Japan
| | - Masataka Kasahara
- Department of Pharmacology, Tokyo Dental College, 2-9-18, Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan.
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Abstract
PURPOSE OF REVIEW To discuss treatments used to enhance growth in pediatric patients with short stature. RECENT FINDINGS New data confirm the known efficacy of recombinant human growth hormone (rhGH) in growth hormone deficiency (GHD) and idiopathic short stature. The latest data from the Safety and Appropriateness of Growth hormone Treatment in Europe cohort did not indicate a long-term risk of malignancy in those treated for isolated GHD, but possibly increased risk in those with other diagnoses. Recombinant human insulin-like growth factor 1 is effective in treating patients with pregnancy-associated plasma protein A2 deficiency. Gonadotropin-releasing hormone agonists or aromatase inhibitor treatment to delay puberty remains controversial. They are more likely to augment adult height if combined with rhGH treatment in children already receiving rhGH. Preliminary data indicate that recombinant C-type natriuretic peptide (CNP) is safe in children and increases growth velocity upon 42 months of treatment in achondroplasia. SUMMARY Recent data confirms previous data on rhGH efficacy and safety. Therapies to delay growth plate closure have greatest efficacy to augment height if combined with GH in select diagnoses. Recombinant CNP holds promise as a medical treatment for short stature associated with achondroplasia.
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Affiliation(s)
- Juanita K Hodax
- Division of Pediatric Endocrinology, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
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21
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Quitmann J, Bloemeke J, Silva N, Bullinger M, Witt S, Akkurt I, Dunstheimer D, Vogel C, Böttcher V, Kuhnle Krahl U, Bettendorf M, Schönau E, Fricke-Otto S, Keller A, Mohnike K, Dörr HG. Quality of Life of Short-Statured Children Born Small for Gestational Age or Idiopathic Growth Hormone Deficiency Within 1 Year of Growth Hormone Treatment. Front Pediatr 2019; 7:164. [PMID: 31111024 PMCID: PMC6501464 DOI: 10.3389/fped.2019.00164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
Aside from clinical endpoints like height gain, health-related quality of life has also become an important outcome indicator in the medical field. However, the data on short stature and health-related quality of life is inconsistent. Therefore, we examined changes in health-related quality of life in German children with idiopathic growth hormone deficiency or children born small for gestational age before and after 12 months of human growth hormone treatment. Children with idiopathic short stature without treatment served as a comparison group. At baseline, health-related quality of life data of 154 patients with idiopathic growth hormone deficiency (n = 65), born small for gestational age (n = 58), and idiopathic short stature (n = 31) and one parent each was collected. Of these, 130 completed health-related quality of life assessments after 1-year of human growth hormone treatment. Outcome measures included the Quality of Life in Short Stature Youth questionnaire, as well as clinical and sociodemographic data. Our results showed that the physical, social, and emotional health-related quality of life of children treated with human growth hormone significantly increased, while untreated patients with idiopathic short stature reported a decrease in these domains. Along with this, a statistically significant increase in height in the treated group can be observed, while the slight increase in the untreated group was not significant. In conclusion, the results showed that human growth hormone treatment may have a positive effect not only on height but also in improving patient-reported health-related quality of life of children with idiopathic growth hormone deficiency and children born small for gestational age.
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Affiliation(s)
- Julia Quitmann
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janika Bloemeke
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neuza Silva
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Monika Bullinger
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilker Akkurt
- Children and Adolescent Endocrinology, MVZ am AKK GmbH, Hamburg, Germany
| | | | - Christian Vogel
- Clinic for Children and Adolescent Medicine, Chemnitz Hospital, Chemnitz, Germany
| | | | | | - Markus Bettendorf
- Center for Children and Adolescent Medicine, University Clinic of Heidelberg, Heidelberg, Germany
| | - Eckhard Schönau
- Pediatric Endocrinology, University Clinic of Cologne, Cologne, Germany
| | - Susanne Fricke-Otto
- Center for Children and Adolescent Medicine, HELIOS Hospital, Krefeld, Germany
| | | | - Klaus Mohnike
- University Children's Clinic, Otto von Geuricke University, Magdeburg, Germany
| | - Helmuth-Günther Dörr
- Clinic for Children and Adolescents, Erlangen-Nürnberg Universtiy, Erlangen, Germany
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