Comparison of weight- vs body surface area-based growth hormone dosing for children: implications for response

• Published in: Clinical endocrinology (Oxford) 2014-03, Vol.80 (3), p.384-394
• Main Authors: Hughes, Ian P., Harris, Mark, Cotterill, Andrew, Ambler, Geoffrey, Cowell, Christopher T., Cutfield, Wayne S., Werther, George, Choong, Catherine S.
• Format: Article
• Language: English
• Subjects: Australia - epidemiology; Biological and medical sciences; Body Height; Body Surface Area; Body Weight; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Dosage Calculations; Endocrinopathies; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; General aspects; Growth Disorders - diagnosis; Growth Disorders - drug therapy; Growth Disorders - epidemiology; Human Growth Hormone - administration & dosage; Humans; Male; Medical sciences; Treatment Outcome; Vertebrates: endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.12315

Summary Objective To compare weight (per kg)‐ vs body surface area (BSA, per m2)‐based growth hormone (GH) dosing formats in children and to derive a useful conversion formula between the two formats. Patients and Design Growth hormone doses (>33 000) from 1874 children were obtained from the national Australian database (OZGROW) and used to derive conversion formulae and to confirm the accuracy of a conversion formula based on a weight‐only BSA estimate. A further 27 000 doses were used to test the accuracy of all formulae. The best conversion formula was used to compare weight‐ and surface area‐based GH dosing, which included an analysis of first year response (∆SDS height or growth velocity, GV). Measurements Growth hormone doses in mg/m2/wk and mg/kg/wk, dose estimates, residuals, first year ∆SDS, first year GV. Results The formula, Dosekg= (4Wtkg+7Wtkg+90 )Dosem2/Wtkg, based on a weight‐only BSA estimate, provides accurate dose conversion (mean residual, 0·005 mg/kg/week). A constant mg/m2/week dose expressed in terms of mg/kg/week declines quickly with increasing body weight to approximately 15 kg after which the decline continues although less dramatically. For Australian patients, despite an increase in mean per m2 dose with increased starting weight/age, the per kg dose decreased. This was associated with a greater decline in first year GV than estimated if a per kg dose had been maintained. Conclusions Growth hormone doses can be accurately converted between formats. Surface area‐based GH dosing is likely to result in a reduced height response as children become heavier when compared with weight‐based GH dosing.