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Long-Term Treatment with Recombinant Insulin-Like Growth Factor (IGF)-I in Children with Severe IGF-I Deficiency due to Growth Hormone Insensitivity

Department of Pediatrics (S.D.C., P.F.B.), University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229; Tercica, Inc. (J.K.), Brisbane, California 94005; Independant Consultant (J.F.), Santa Monica, California 90403; and Department of Pediatrics (L.E.U.), University of North Carolina, Chapel Hill, North Carolina 27599

Address all correspondence and requests for reprints to: Steven D. Chernausek, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229. E-mail: steven.chernausek{at}cchmc.org.

Context: Children with severe IGF-I deficiency due to congenital or acquired defects in GH action have short stature that cannot be remedied by GH treatment.

Objectives: The objective of the study was to examine the long-term efficacy and safety of recombinant human IGF-I (rhIGF-I) therapy for short children with severe IGF-I deficiency.

Design: Seventy-six children with IGF-I deficiency due to GH insensitivity were treated with rhIGF-I for up to 12 yr under a predominantly open-label design.

Setting: The study was conducted at general clinical research centers and with collaborating endocrinologists.

Subjects: Entry criteria included: age older than 2 yr, SD scores for height and circulating IGF-I concentration less than –2 for age and sex, and evidence of resistance to GH.

Intervention: rhIGF-I was administered sc in doses between 60 and 120 µg/kg twice daily.

Main Outcome Measures: Height velocity, skeletal maturation, and adverse events were measured.

Results: Height velocity increased from 2.8 cm/yr on average at baseline to 8.0 cm/yr during the first year of treatment (P < 0.0001) and was dependent on the dose administered. Height velocities were lower during subsequent years but remained above baseline for up to 8 yr. The most common adverse event was hypoglycemia, which was observed both before and during therapy. It was reported by 49% of treated subjects. The next most common adverse events were injection site lipohypertrophy (32%) and tonsillar/adenoidal hypertrophy (22%).

Conclusions: Treatment with rhIGF-I stimulates linear growth in children with severe IGF-I deficiency due to GH insensitivity. Adverse events are common but are rarely of sufficient severity to interrupt or modify treatment.

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