Safety and Effectiveness of Recombinant Human Growth Hormone in Children with Turner Syndrome: Data from the PATRO Children Study

Introduction: PATRO Children is an international, observational, postmarketing surveillance study for a biosimilar recombinant human growth hormone (rhGH; somatropin, Omnitrope®; Sandoz), approved by the European Medicines Agency in 2006. We report safety and effectiveness data for patients with Turner syndrome (TS). Methods: The study population included infants, children, and adolescents with TS who received Omnitrope® treatment according to standard clinical practice. Adverse events (AEs) were monitored for safety evaluation, and height velocity (HV), height standard deviation score (HSDS), and HVSDS were calculated to evaluate treatment effectiveness. Results: As of August 2019, 348 TS patients were enrolled from 130 centers. At baseline, 314 patients (90.2%) were prepubertal and 284 patients (81.6%) were rhGH treatment naïve. The mean (range) age at baseline was 9.0 (0.7–18.5) years, and mean (SD) treatment duration in the study was 38.5 (26.8) months. Overall, 170 patients (48.9%) reported AEs, which were considered treatment related in 25 patients (7.2%). One treatment-related serious AE was reported (intracranial hypertension). Mean ΔHSDS after 3 years of therapy was +1.17 in treatment-naïve prepubertal patients and +0.1 in pretreated prepubertal patients. In total, 51 patients (31.1%) reached adult height (AH), 35 of whom were rhGH treatment naïve; in these patients, mean (SD) HSDS was −2.97 (1.03) at the start of Omnitrope® treatment, and they achieved a mean (SD) AHSDS of −2.02 (0.9). Conclusion: These data suggest that biosimilar rhGH is well tolerated and effective in TS patients managed in real-life clinical practice. Optimization of rhGH dose may contribute to a higher AH.

[1]  C. Gravholt,et al.  Turner syndrome: mechanisms and management , 2019, Nature Reviews Endocrinology.

[2]  Sagad Omer Obeid Mohamed,et al.  Prevalence of autoimmune thyroid diseases among the Turner Syndrome patients: meta-analysis of cross sectional studies , 2018, BMC Research Notes.

[3]  S. Kirsch,et al.  Growth hormone treatment of Canadian children: results from the GeNeSIS phase IV prospective observational study. , 2018, CMAJ open.

[4]  S. Senniappan,et al.  Mode of clinical presentation and delayed diagnosis of Turner syndrome: a single Centre UK study , 2018, International Journal of Pediatric Endocrinology.

[5]  J. Wit,et al.  Growth hormone — past, present and future , 2018, Nature Reviews Endocrinology.

[6]  L. Robison,et al.  Mortality in Children Receiving Growth Hormone Treatment of Growth Disorders: Data From the Genetics and Neuroendocrinology of Short Stature International Study , 2017, The Journal of clinical endocrinology and metabolism.

[7]  Olaf M Dekkers,et al.  Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. , 2017, European journal of endocrinology.

[8]  Lisal J. Folsom,et al.  Reproductive Issues in Women with Turner Syndrome. , 2015, Endocrinology and metabolism clinics of North America.

[9]  H. Christesen,et al.  Noonan syndrome and Turner syndrome patients respond similarly to 4 years’ growth-hormone therapy: longitudinal analysis of growth-hormone-naïve patients enrolled in the NordiNet® International Outcome Study and the ANSWER Program , 2015, International Journal of Pediatric Endocrinology.

[10]  H. Timmers,et al.  Safety and Efficacy of Oxandrolone in Growth Hormone-Treated Girls with Turner Syndrome: Evidence from Recent Studies and Recommendations for Use , 2014, Hormone Research in Paediatrics.

[11]  Hae-sang Lee,et al.  Response to three years of growth hormone therapy in girls with Turner syndrome , 2013, Annals of pediatric endocrinology & metabolism.

[12]  M. Szalecki,et al.  Design of, and first data from, PATRO Children, a multicentre, noninterventional study of the long-term efficacy and safety of Omnitrope® in children requiring growth hormone treatment , 2013, Therapeutic advances in endocrinology and metabolism.

[13]  M. Hermanussen,et al.  Harmonizing national growth references for multi-centre surveys, drug monitoring and international postmarketing surveillance , 2012, Acta paediatrica.

[14]  D. Larizza,et al.  Prevalence and incidence of scoliosis in Turner syndrome: a study in 49 girls followed-up for 4 years. , 2011, European journal of physical and rehabilitation medicine.

[15]  J. Ross,et al.  Prospective Study Confirms Oxandrolone-Associated Improvement in Height in Growth Hormone-Treated Adolescent Girls with Turner Syndrome , 2010, Hormone Research in Paediatrics.

[16]  C. Gravholt,et al.  Increased prevalence of autoimmunity in Turner syndrome – influence of age , 2009, Clinical and experimental immunology.

[17]  F. Darendeliler,et al.  Headache, Idiopathic Intracranial Hypertension and Slipped Capital Femoral Epiphysis during Growth Hormone Treatment: A Safety Update from the KIGS Database , 2007, Hormone Research in Paediatrics.

[18]  R. Milne,et al.  Recombinant growth hormone for children and adolescents with Turner syndrome. , 2007, The Cochrane database of systematic reviews.

[19]  T. Cole,et al.  The Calculation of Target Height Reconsidered , 2003, Hormone Research in Paediatrics.

[20]  T. Stijnen,et al.  Final height in girls with turner syndrome after long-term growth hormone treatment in three dosages and low dose estrogens. , 2003, The Journal of clinical endocrinology and metabolism.

[21]  L. Sävendahl,et al.  Delayed diagnoses of Turner's syndrome: proposed guidelines for change. , 2000, The Journal of pediatrics.

[22]  A. Rosenthal,et al.  Pseudoautosomal deletions encompassing a novel homeobox gene cause growth failure in idiopathic short stature and Turner syndrome , 1997, Nature Genetics.

[23]  J M Tanner,et al.  Standards for Children's Height at Ages 2-9 Years Allowing for Height of Parents , 1970, Archives of disease in childhood.

[24]  P. Backeljauw,et al.  Current best practice in the management of Turner syndrome , 2018, Therapeutic advances in endocrinology and metabolism.

[25]  K. Parker,et al.  Long-term safety of recombinant human growth hormone in children. , 2010, The Journal of clinical endocrinology and metabolism.

[26]  Brenda J. Crowe,et al.  Growth hormone treatment of early growth failure in toddlers with Turner syndrome: a randomized, controlled, multicenter trial. , 2007, The Journal of clinical endocrinology and metabolism.

[27]  S. Pruhova,et al.  IGF-I Resistance and Turner's Syndrome , 2001, Journal of pediatric endocrinology & metabolism : JPEM.

[28]  M. Ranke,et al.  Prediction of long-term response to recombinant human growth hormone in Turner syndrome: development and validation of mathematical models. KIGS International Board. Kabi International Growth Study. , 2000, The Journal of clinical endocrinology and metabolism.