Five-year response to growth hormone in children with Noonan syndrome and growth hormone deficiency

BACKGROUND: Noonan syndrome (NS) is an autosomal dominant disorder characterized by specific features including short stature, distinctive facial dysmorphic features, congenital heart defects, hypertrophic cardiomyopathy, skeletal anomalies and webbing of the neck. Molecular screening has shown that the majority of individuals with NS have a mutation in the PTPN11 gene. Noonan syndrome children may show an impaired growth hormone (GH)/insulin-like growth factor axis. Moreover, recombinant human GH (rhGH) has been shown to improve growth rate in patients with NS, although data are still limited. METHODS: In the present study, we assessed growth response following GH therapy (0.25 mg/Kg/week) in 5 (2 M and 3 F) GH-deficient NS patients (NSGHD, mean age 8.5 years) and in 5 (2 M and 3 F) idiopathic GH deficient (IGHD, mean age 8.6 years) patients. We also evaluated the safety of rhGH therapy in NS patients with GHD. RESULTS: At the beginning of GH treatment, height and growth rate were statistically lower in NSGHD children than in IGHD ones. During the first three years of rhGH therapy, NSGHD patients showed a slight improvement in height (from −2.71 SDS to −2.44 SDS) and growth rate (from −2.42 SDS to −0.23 SDS), although the values were always significantly lower than in IGHD children. After five years of rhGH treatment, height gain was higher in IGHD children (mean 28.3 cm) than in NSGHD patients (mean 23.6 cm). During the first five years of rhGH therapy, regular cardiological and haematological check-ups were performed, leading to the conclusion that rhGH therapy was safe. CONCLUSIONS: In conclusion, pre-pubertal NS children with GHD slightly increased their height and growth rate during the first years of GH therapy, although the response to rhGH treatment was significantly lower than IGHD children. Furthermore, the therapy appeared to be safe since no severe adverse effects were reported, at least during the first five years. However, a close follow-up of these patients is mandatory, especially to monitor cardiac function

Product wastage from modern human growth hormone administration devices: a laboratory and computer simulation analysis

Richard F Pollock,1 Yujun Qian,2 Tami Wisniewski,3 Lisa Seitz,4 Anne-Marie Kappelgaard2 1Ossian Health Economics and Communications GmbH, Basel, Switzerland; 2Novo Nordisk AS, Bagsv&aelig;rd, Denmark; 3Novo Nordisk Inc, Princeton, NJ, USA; 4Novo Nordisk Pharma GmbH, Mainz, Germany Background: Treatment of growth hormone disorders typically involves daily injections of human growth hormone (GH) over many years, incurring substantial costs. We assessed the extent of undesired GH loss due to leakage in the course of pen preparation prior to injection, and differences between the prescribed dose, based on patient weight, and the actual delivered dose based on pen dosing increments in five GH administration devices. Methods: Norditropin&reg; prefilled FlexPro&reg;, NordiFlex&reg;, NordiLet&reg;, and durable NordiPen&reg;/SimpleXx&reg; 5 mg pens (Novo Nordisk A/S, Bagsv&aelig;rd, Denmark) and durable Omnitrope&reg; Pen-5 devices (Sandoz, Holzkirchen, Germany) were tested (n = 40 for each device type). Product wastage was measured in accordance with validated protocols in an ISO (International Organization for Standardization) 11608-1 and Good Manufacturing Practice compliant laboratory. The average mass of wasted GH from each device type was measured in simulations of dripping with the needle attached prior to injection and while setting a dose. Statistical significance (P < 0.05) was confirmed by Student&#39;s t-test, and a model was constructed to estimate mean annual GH wastage per patient in cohorts of pediatric patients with GH disorders. Results: Mean GH mass wasted with the needle on prior to injection was 0.0 &micro;g with Norditropin pens, relative to 98 &micro;g with Omnitrope Pen-5. During dose dialing, 0.0&ndash;2.3 &micro;g of GH was lost with Norditropin pens versus 0.8 &micro;g with Omnitrope Pen-5. All Norditropin and Omnitrope device comparisons were statistically significant. Modeling GH wastage in a US cohort showed 5.5 mg of annual GH wastage per patient with FlexPro versus 43.6 mg with Omnitrope, corresponding to 7&ndash;8 additional pens per patient annually. Conclusion: Overall, Norditropin pens resulted in significantly less wastage than the Omnitrope Pen-5. The study suggests that GH devices of the same nominal volume exhibit differences that may affect the frequency of GH prescription refills required to remain adherent to therapy. Keywords: human growth hormone, administration, dosage, injections, subcutaneous, computer model