Is GH dosing optimal in female patients with adult-onset GH deficiency? An analysis from the NordiNet® International Outcome Study

Summary

Objective

To evaluate gender differences in GH dosing, IGF-I and cardiovascular risk markers in adults with GH deficiency (GHD).

Design

NordiNet^® International Outcome Study (NCT00960128), a non-interventional, multicentre study, evaluates the long-term effectiveness and safety of Norditropin^® (Novo Nordisk A/S) in the real-life clinical setting.

Patients

Non-diabetic patients (n=252; 41.7% female) with adult-onset GHD (age ≥20 years at GH start), ≥4 years' GH therapy, and glycosylated haemoglobin (HbA_1c) data at baseline and 4 years.

Measurements

Effects of gender (adjusted for baseline age and body mass index [BMI], average GH dose, treatment duration, and concomitant medication) on change from baseline to 4 years (∆) in HbA_1c, fasting plasma glucose (FPG), IGF-I, lipids and waist circumference were evaluated.

Results

GH dose (mean [SE]; mg/day) was similar between females (0.22 [0.02]) and males (0.21 [0.01]) at baseline, but higher in females from year 1 (year 4, females, 0.45 [0.03]; males, 0.32 [0.02]). Mean IGF-I standard deviation score [SDS] was lower in females vs males at each treatment year; more than one-third of females still had an IGF-I SDS below 0 at year 4, compared with only 21.8% of men. An adverse lipid profile at baseline remained poor in more females than males at 4 years. Improvement in total cholesterol was significantly associated with gender (P < 0.0001), improving less in females than in males.

Conclusions

These data highlight that, even after 4 years, GH dose is sub-optimal in many female patients, which may impact clinical outcomes; therefore, GH titration for women requires further improvement.

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