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Efficacy and safety of growth hormone treatment in adults with growth hormone deficiency: a systematic review of studies on morbidity

van Bunderen, Christa C.; van Varsseveld, Nadege C.; Erfurth, Eva Marie LU ; Ket, Johannes C. F. and Drent, Madeleine L. (2014) In Clinical Endocrinology 81(1). p.1-14
Abstract
Due to the positive effects demonstrated in randomized clinical trials on cardiovascular surrogate markers and bone metabolism, a positive effect of growth hormone (GH) treatment on clinically relevant end-points seems feasible. In this review, we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency (GHD) with emphasis on morbidity: fatal and nonfatal cardiovascular disease (CVD) and stroke, fractures, fatal and nonfatal malignancies and recurrences, and diabetes mellitus. A positive effect of GH treatment on CVD and fracture risk could be concluded, but study design limitations have to be considered. Stroke and secondary brain tumours remained more prevalent. However, other... (More)
Due to the positive effects demonstrated in randomized clinical trials on cardiovascular surrogate markers and bone metabolism, a positive effect of growth hormone (GH) treatment on clinically relevant end-points seems feasible. In this review, we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency (GHD) with emphasis on morbidity: fatal and nonfatal cardiovascular disease (CVD) and stroke, fractures, fatal and nonfatal malignancies and recurrences, and diabetes mellitus. A positive effect of GH treatment on CVD and fracture risk could be concluded, but study design limitations have to be considered. Stroke and secondary brain tumours remained more prevalent. However, other contributing factors have to be taken into account. Regrowth and recurrences of (peri) pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment. All fatal and nonfatal malignancies were not more prevalent in GH-treated adults compared to the general population. However, follow-up time is still relatively short. The studies on diabetes are difficult to interpret, and more evidence is awaited. In clinical practice, a more individualized assessment seems appropriate, taking into consideration the underlying diagnosis of GHD, other treatment regimens, metabolic profile and the additional beneficial effects of GH set against the possible risks. Large and thoroughly conducted observational studies are needed and seem the only feasible way to inform the ongoing debate on health care costs, drug safety and clinical outcomes. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Endocrinology
volume
81
issue
1
pages
1 - 14
publisher
Wiley-Blackwell
external identifiers
  • wos:000337735900001
  • scopus:84902493825
ISSN
1365-2265
DOI
10.1111/cen.12477
language
English
LU publication?
yes
id
cf6ebbf0-e7d7-4b9a-b087-eed166de4214 (old id 4609327)
date added to LUP
2014-09-01 07:41:10
date last changed
2017-05-21 03:25:52
@article{cf6ebbf0-e7d7-4b9a-b087-eed166de4214,
  abstract     = {Due to the positive effects demonstrated in randomized clinical trials on cardiovascular surrogate markers and bone metabolism, a positive effect of growth hormone (GH) treatment on clinically relevant end-points seems feasible. In this review, we discuss the long-term efficacy and safety of GH treatment in adult patients with growth hormone deficiency (GHD) with emphasis on morbidity: fatal and nonfatal cardiovascular disease (CVD) and stroke, fractures, fatal and nonfatal malignancies and recurrences, and diabetes mellitus. A positive effect of GH treatment on CVD and fracture risk could be concluded, but study design limitations have to be considered. Stroke and secondary brain tumours remained more prevalent. However, other contributing factors have to be taken into account. Regrowth and recurrences of (peri) pituitary tumours were not increased in patients with GH treatment compared to similar patients without GH treatment. All fatal and nonfatal malignancies were not more prevalent in GH-treated adults compared to the general population. However, follow-up time is still relatively short. The studies on diabetes are difficult to interpret, and more evidence is awaited. In clinical practice, a more individualized assessment seems appropriate, taking into consideration the underlying diagnosis of GHD, other treatment regimens, metabolic profile and the additional beneficial effects of GH set against the possible risks. Large and thoroughly conducted observational studies are needed and seem the only feasible way to inform the ongoing debate on health care costs, drug safety and clinical outcomes.},
  author       = {van Bunderen, Christa C. and van Varsseveld, Nadege C. and Erfurth, Eva Marie and Ket, Johannes C. F. and Drent, Madeleine L.},
  issn         = {1365-2265},
  language     = {eng},
  number       = {1},
  pages        = {1--14},
  publisher    = {Wiley-Blackwell},
  series       = {Clinical Endocrinology},
  title        = {Efficacy and safety of growth hormone treatment in adults with growth hormone deficiency: a systematic review of studies on morbidity},
  url          = {http://dx.doi.org/10.1111/cen.12477},
  volume       = {81},
  year         = {2014},
}