Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. A pilot study

Guillem Cuatrecasas, Cristina Riudavets, Maria Antònia Güell, Albert Nadal, Guillem Cuatrecasas, Cristina Riudavets, Maria Antònia Güell, Albert Nadal

Abstract

Background: There is evidence of functional growth hormone (GH) deficiency, expressed by means of low insulin-like growth factor 1 (IGF-1) serum levels, in a subset of fibromyalgia patients. The efficacy of GH versus placebo has been previously suggested in this population. We investigated the efficacy and safety of low dose GH as an adjunct to standard therapy in the treatment of severe, prolonged and well-treated fibromyalgia patients with low IGF-1 levels.

Methods: Twenty-four patients were enrolled in a randomized, open-label, best available care-controlled study. Patients were randomly assigned to receive either 0.0125 mg/kg/d of GH subcutaneously (titrated depending on IGF-1) added to standard therapy or standard therapy alone during one year. The number of tender points, the Fibromyalgia Impact Questionnaire (FIQ) and the EuroQol 5D (EQ-5D), including a Quality of Life visual analogic scale (EQ-VAS) were assessed at different time-points.

Results: At the end of the study, the GH group showed a 60% reduction in the mean number of tender points (pairs) compared to the control group (p < 0.05; 3.25 +/- 0.8 vs. 8.25 +/- 0.9). Similar improvements were observed in FIQ score (p < 0.05) and EQ-VAS scale (p < 0.001). There was a prompt response to GH administration, with most patients showing improvement within the first months in most of the outcomes. The concomitant administration of GH and standard therapy was well tolerated, and no patients discontinued the study due to adverse events.

Conclusion: The present findings indicate the advantage of adding a daily GH dose to the standard therapy in a subset of severe fibromyalgia patients with low IGF-1 serum levels.

Trial registration: NCT00497562 (ClinicalTrials.gov).

Figures

Figure 1
Figure 1
Mean (CI) number of tender points. *p < 0.05 vs control group (ANCOVA); p = 0.001 time course within-group comparisons (repeated measures ANOVA) (statistical analysis performed with values expressed as pairs of tender points).
Figure 2
Figure 2
Percentage of patients with pain in each of the 9 bilateral tender point sites. *p < 0.05 vs control group (chi-square test).
Figure 3
Figure 3
Mean (CI) total score of Fibromyalgia Impact Questionnaire. *p < 0.05 vs control group (ANCOVA); p = 0.001 time course within-group comparisons (repeated measures ANOVA).
Figure 4
Figure 4
Mean (CI) score of EQ-VAS. *p < 0.05 vs control group (ANCOVA); p = 0.001 time course within-group comparisons (repeated measures ANOVA).

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