Real-World Adult Height Outcomes in Girls with Central Precocious Puberty Receiving GnRHa Monotherapy or Combined with Growth Hormone: A Cohort Study in China.
Combination therapy with GnRHa and rhGH may improve height outcomes in girls with CPP, especially those with severe height impairment, but results are specific to the studied population.
Where it sits
this study against the rest of the hgh (somatropin) corpusSummary and findings
This study evaluated the efficacy of GnRHa monotherapy versus GnRHa combined with rhGH in Chinese girls with central precocious puberty. The GnRHa group showed an adult height gain of 1.33 SDS after 17.87 months, while the combination group showed a gain of 1.72 SDS after 23.02 months of GnRHa and 14.02 months of rhGH treatment. The combination therapy was associated with greater height gains in patients with severe baseline height impairment.
Abstract
Introduction Although gonadotropin-releasing hormone analogs (GnRHa) are the standard treatment for central precocious puberty (CPP), the efficacy of GnRHa monotherapy in older children (around 8 years) and that of combination therapy with recombinant human growth hormone (rhGH) both remain unclear. This study aims to evaluate the real-world efficacy of each regimen. Methods This retrospective cohort study enrolled Chinese girls with CPP. Two groups were formed: GnRHa monotherapy and GnRHa + rhGH combination therapy. Outcomes included adult height gain [AHG, final adult height (FAH) standard deviation score (SDS)- predicted adult height (PAH) SDS]，genetic height gain [GHG, FAH SDS-target height (Tht) SDS], and change in height (FAH SDS - baseline height SDS). Results In the GnRHa group, the mean age at treatment initiation was 8.87 ± 0.87 years. After 17.87 months of treatment, the AHG was 1.33 SDS (0.82, 2.00). In the GnRHa + rhGH group, the mean age at treatment initiation was 9.01 ± 0.80 years. After 23.02 months of GnRHa treatment and 14.02 months of rhGH treatment, the group showed significantly greater AHG [1.72 SDS (1.24, 2.59)]. Conclusions GnRHa monotherapy initiated after age 8 may still provide meaningful height gains, and adding rhGH is associated with improved FAH in patients with severe baseline height impairment.
Background
Central precocious puberty (CPP) is a condition where puberty begins at an unusually early age, often leading to reduced adult height due to premature closure of growth plates. GnRHa is the standard treatment to delay puberty and improve height outcomes, but its efficacy in older children and when combined with growth hormone remains unclear. This study addresses the gap by evaluating real-world height outcomes in girls treated with GnRHa alone or in combination with rhGH.
Methods
This retrospective cohort study involved Chinese girls diagnosed with CPP. Participants were divided into two groups: those receiving GnRHa monotherapy and those receiving a combination of GnRHa and rhGH. The primary outcomes measured were adult height gain (AHG), genetic height gain (GHG), and change in height SDS from baseline. The mean age at treatment initiation was 8.87 years for the GnRHa group and 9.01 years for the combination group.
Results
In the GnRHa monotherapy group, after 17.87 months of treatment, the mean adult height gain was 1.33 SDS. In the combination therapy group, after 23.02 months of GnRHa and 14.02 months of rhGH, the adult height gain was significantly greater at 1.72 SDS. The combination therapy showed enhanced final adult height outcomes, particularly in those with severe baseline height impairment.
Interpretation
The findings suggest that while GnRHa monotherapy can provide meaningful height gains in older children with CPP, the addition of rhGH may offer further benefits, particularly for those with significant height deficits. However, the retrospective nature and specific demographic limit the generalizability of the results. The effect size, while statistically significant, should be interpreted with caution regarding its clinical significance.
Key findings
- Mean age at treatment initiation in GnRHa group: 8.87 ± 0.87 years.
- GnRHa group AHG: 1.33 SDS (0.82, 2.00) after 17.87 months.
- Mean age at treatment initiation in GnRHa + rhGH group: 9.01 ± 0.80 years.
- GnRHa + rhGH group AHG: 1.72 SDS (1.24, 2.59) after 23.02 months of GnRHa and 14.02 months of rhGH.
- Combination therapy associated with improved FAH in severe baseline height impairment.
Limitations
- Retrospective study design
- Specific to Chinese girls
- Limited generalizability
- Short follow-up for rhGH treatment