I M Holdaway1, P Hunt2, P Manning3, W Cutfield4, G Gamble5, N Ninow6, D Staples-Moon6, P Moodie6, S Metcalfe6. 1. Department of Endocrinology, Auckland Hospital and Greenlane Clinical Centre, Auckland, New Zealand. 2. Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand. 3. Department of Endocrinology, Dunedin Hospital, Dunedin, New Zealand. 4. Liggins Institute, Auckland University School of Medicine, Auckland, New Zealand. 5. Department of Medicine, University of Auckland School of Medicine, Auckland, New Zealand. 6. Pharmaceutical Management Agency, Wellington, New Zealand.
Abstract
OBJECTIVE: Treatment of growth hormone (GH)-deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported. DESIGN: Retrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists. PATIENTS: Applications for 201 patients were assessed and 191 approved for funded treatment over the initial 3 years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary. RESULTS: After an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA(®) instrument (baseline (95%CI) 19 (18-21), 9 months 6 (5-7.5)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2.8 ± 0.6 cm. The mean maintenance GH dose after 9 months of treatment was 0.39 mg/day. After 3 years, 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9 months of treatment. CONCLUSION: Carefully designed access to nationally funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.
OBJECTIVE: Treatment of growth hormone (GH)-deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported. DESIGN: Retrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists. PATIENTS: Applications for 201 patients were assessed and 191 approved for funded treatment over the initial 3 years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary. RESULTS: After an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA(®) instrument (baseline (95%CI) 19 (18-21), 9 months 6 (5-7.5)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2.8 ± 0.6 cm. The mean maintenance GH dose after 9 months of treatment was 0.39 mg/day. After 3 years, 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9 months of treatment. CONCLUSION: Carefully designed access to nationally funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.
Authors: Kevin C J Yuen; Bradley S Miller; Cesar L Boguszewski; Andrew R Hoffman Journal: Front Endocrinol (Lausanne) Date: 2021-02-24 Impact factor: 5.555
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Authors: Margaret C S Boguszewski; Adriane A Cardoso-Demartini; Cesar Luiz Boguszewski; Wassim Chemaitilly; Claire E Higham; Gudmundur Johannsson; Kevin C J Yuen Journal: Pituitary Date: 2021-07-25 Impact factor: 4.107