Safety Outcomes During Pediatric GH Therapy: Final Results From the Prospective GeNeSIS Observational Program

Christopher J Child, Alan G Zimmermann, George P Chrousos, Elisabeth Cummings, Cheri L Deal, Tomonobu Hasegawa, Nan Jia, Sarah Lawrence, Agnès Linglart, Sandro Loche, Mohamad Maghnie, Jacobo Pérez Sánchez, Michel Polak, Barbara Predieri, Annette Richter-Unruh, Ron G Rosenfeld, Diego Yeste, Tohru Yorifuji, Werner F Blum, Christopher J Child, Alan G Zimmermann, George P Chrousos, Elisabeth Cummings, Cheri L Deal, Tomonobu Hasegawa, Nan Jia, Sarah Lawrence, Agnès Linglart, Sandro Loche, Mohamad Maghnie, Jacobo Pérez Sánchez, Michel Polak, Barbara Predieri, Annette Richter-Unruh, Ron G Rosenfeld, Diego Yeste, Tohru Yorifuji, Werner F Blum

Abstract

Context: Safety concerns have been raised regarding premature mortality, diabetes, neoplasia, and cerebrovascular disease in association with GH therapy.

Objective: To assess incidence of key safety outcomes.

Design: Prospective, multinational, observational study (1999 to 2015).

Setting: A total of 22,311 GH-treated children from 827 investigative sites in 30 countries.

Patients: Children with growth disorders.

Interventions: GH treatment.

Main outcome measures: Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) with 95% CIs for mortality, diabetes, and primary cancer using general population registries.

Results: Predominant short stature diagnoses were GH deficiency (63%), idiopathic short stature (13%), and Turner syndrome (8%), with mean ± SD follow-up of 4.2 ± 3.2 years (∼92,000 person-years [PY]). Forty-two deaths occurred in patients with follow-up, with an SMR (95% CI) of 0.61 (0.44, 0.82); the SMR was elevated for patients with cancer-related organic GH deficiency [5.87 (3.21, 9.85)]. Based on 18 cases, type 2 diabetes mellitus (T2DM) risk was elevated [SIR: 3.77 (2.24, 5.96)], but 72% had risk factors. In patients without cancer history, 14 primary cancers were observed [SIR: 0.71 (0.39, 1.20)]. Second neoplasms occurred in 31 of 622 cancer survivors [5.0%; 10.7 (7.5, 15.2) cases/1000 PY] and intracranial tumor recurrences in 67 of 823 tumor survivors [8.1%; 16.9 (13.3, 21.5) cases/1000 PY]. All three hemorrhagic stroke cases had risk factors.

Conclusions: GeNeSIS (Genetics and Neuroendocrinology of Short Stature International Study) data support the favorable safety profile of pediatric GH treatment. Overall risk of death or primary cancer was not elevated in GH-treated children, and no hemorrhagic strokes occurred in patients without risk factors. T2DM incidence was elevated compared with the general population, but most cases had diabetes risk factors.

Trial registration: ClinicalTrials.gov NCT01088412.

Figures

Figure 1.
Figure 1.
GeNeSIS patient disposition and main analysis populations.

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