Ergun ÇETİNKAYA, Ayşe Esin KİBAR, Zehra AYCAN, Seçil ÖZKAN

Büyüme Hormonu Eksikliği Olan Çocuklarda Klasik Büyüme Hormonu Tedavisi Dozunu Azaltmak Mümkün mü?

Amaç: Düşük doz büyüme hormon tedavisi ile sağlanabilecek maddi kazanç ihtimalini ortaya koymak için bu çalışma planlandı. Olgular ve Metod: Büyüme hormonu eksikliği olan 97 çocuk 2 grupta incelendi. 1)Çalışma grubuna (n=39) rekombinant insan büyüme hormonu (rhGH) 0.15 mg/kg/ hafta dozunda verildi. 2)Kontrol grubuna (n=58), rhGH klasik doz olan 0.2 mg/kg / hafta dozunda verildi. Tüm olgular çalışma başlangıcında ve büyüme hormon tedavisinin 6. ve 12.aylarında değerlendirilip oksolojik kontrolleri yapıldı ve insülin benzeri büyüme faktörü (IGF-1) ile insülin benzeri büyüme faktörü bağlayıcı protein -3 (IGFBP-3) seviyeleri ölçüldü. Bulgular: Kontrol grubu ile karşılaştırıldığında çalışma grubunda: Tedavinin 6.ayında IGF-1, IGFBP3, büyüme hızı (GV) ve büyüme hızı SDS (GVSDS) değerlerinde istatistiksel anlamlı fark bulunamazken, tedavinin 12.ayında kontrol grubunda GV ve GVSDS seviyeleri anlamlı yüksek bulundu. Bu fark kontrol grubunda bu dönemde gözlenen pubertal sıçramaya bağlandı. Her 2 grupta; GV ve GVSDS ile parental boy, hedef boy, IGF-1, IGFBP-3 değerleri arasında istatistiksel anlamlı fark bulunamadı. Sonuç: Büyüme hormonu tedavisinde halen kullanılmakta olan konvansiyonel dozun azaltılması büyüme üzerinde anlamlı olumsuz etki yapmadığından daha düşük doz tedavi ile tedavi maliyetlerinde yaklaşık %20 civarında azalma sağlanabilir ki, bu tüm ülkeler için total tedavi harcamalarını azaltmada çok önemli bir kazanç olabilir.

Anahtar Kelimeler:

Büyüme hormonu tedavisi, IGF1, IGFBP3

IS IT POSSIBLE TO DECREASE THE CONVENTIONAL GROWTH HORMONE DOSAGE IN GROWTH-DEFICIENT CHILDREN?

Objective: The prospect of financial savings by decreasing growth hormone dose, prompted us to study the effectiveness of lower dose treatment. Subjects and methods: We studied 97 growth hormone deficient (GHD) children in two groups: 1) The study group (n=39) was treated with recombinant human GH (rhGH) at a low dose of 0.15 mg/kg/week 2) The control group (n=58) was treated with rhGH, at a conventional dose of 0.2 mg/kg/week. All patients were evaluated for auxology, Insulin like growth factor-1(IGF-1) and Insulin like growth factor binding protein-3(IGFBP3) levels at baseline, 6 and 12 months after starting GH therapy. Results: While there was no significant difference in IGF-1, IGFBP3, growth velocity (GV), and growth velocity SDS (GVSDS) levels after 6 months of therapy between the two groups, the GV and GVSDS levels were significantly higher in the control group after 12 months. This difference contributed to significant pubertal spurt in the control group. In both groups, no significant correlation was found among parental heights, target heights, IGF-1 and IGFBP3 levels with GV and GVSDS. Conclusion: By decreasing the conventional GH treatment dose, we also decrease the cost of GH treatment approximately by 20% which may lead to an important cut in the treatment related cost

Keywords:

Growth hormone replacement therapy, IGF-1, IGFBP3,

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