Growth hormone treatment in Prader-Willi syndrome patients: systematic review and meta-analysis

• Published in: BMJ paediatrics open 2020-04, Vol.4 (1), p.e000630-e000630
• Main Authors: Passone, Caroline de Gouveia Buff, Franco, Ruth Rocha, Ito, Simone Sakura, Trindade, Evelinda, Polak, Michel, Damiani, Durval, Bernardo, Wanderley Marques
• Format: Article
• Language: English
• Subjects: Age; Bias; Body composition; Body mass index; Cognition & reasoning; Cognitive ability; Endocrinology; Gene expression; genetics; growth; growth hormone; Growth hormones; Insulin-like growth factors; Meta-analysis; Muscle strength; Obesity; Patients; Pediatrics; Prader-Willi Syndrome; Quality of life; syndrome; Systematic review; Teenagers
• ISSN: 2399-9772; 2399-9772
• DOI: 10.1136/bmjpo-2019-000630

BackgroundGrowth hormone (GH) treatment is currently recommended in Prader-Willi syndrome (PWS) patients.ObjectivesTo evaluate the impact (efficacy and safety) of the use of recombinant human GH (rhGH) as a treatment for PWS.MethodWe performed a systematic review and, where possible, meta-analysis for the following outcomes: growth, body mass index, body composition, cognitive function, quality of life, head circumference, motor development/strength, behaviour and adverse effects. We included all PWS patients, with all types of genetic defects and with or without GH deficiency, who participated in rhGH studies performed in infancy, childhood and adolescence, that were either randomised controlled trials (RCTs) (double-blinded or not) or non-randomised controlled trials (NRCTs) (cohort and before and after studies). The databases used were MEDLINE, Embase and Cochrane Central.ResultsIn 16 RCTs and 20 NRCTs selected, the treated group had an improvement in height (1.67 SD scores (SDS); 1.54 to 1.81); body mass index z-scores (−0.67 SDS; −0.87 to −0.47) and fat mass proportion (−6.5% SDS; −8.46 to −4.54) compared with the control group. Data about cognition could not be aggregated.ConclusionBased on high quality evidence, rhGH treatment favoured an improvement of stature, body composition and body mass index, modifying the disease’s natural history; rhGH treatment may also be implicated in improved cognition and motor development in PWS patients at a young age.Ethics and disseminationThe current review was approved by the ethical committee of our institution. The results will be disseminated through conference presentations and publications in peer-reviewed journals.PROSPERO registration numberCRD42019140295