GH-IGF-1 axis and rhGH outcomes in children with GHD, ISS and SGA: a systematic review and meta-analysis.
Ashraf T Soliman, Fawzia Alyafei, Nada Alaaraj et al.
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In 30 seconds
This systematic review and meta-analysis compared GH–IGF-1 profiles and recombinant human growth hormone (rhGH) outcomes in children with growth hormone deficiency (GHD), idiopathic short stature (ISS), or persistent short stature after small-for-gestational-age birth (SGA). It included 47 studies and 18,642 children. Baseline IGF-1 SDS was lowest in GHD (-2.9 ± 1.1), versus ISS (-1.5 ± 1.2) and SGA (-1.3 ± 1.1; p<0.001). First-year height velocity was also greater in complete GHD than in ISS (MD +0.80 cm/year; 95 % CI 0.52-1.08) and SGA (MD + 0.62; 95 % CI 0.28-0.96).
Key findings
- Baseline IGF-1 SDS was lower in GHD (-2.9 ± 1.1) than ISS (-1.5 ± 1.2) or SGA (-1.3 ± 1.1; p<0.001).
- Complete GHD had greater first-year height velocity than ISS (MD +0.80 cm/year; 95 % CI 0.52-1.08) and SGA (MD + 0.62; 95 % CI 0.28-0.96).
- One-year ΔHeight SDS favored GHD over ISS (SMD +0.24; 95 % CI 0.17-0.31) and SGA (SMD +0.19; 95 % CI 0.09-0.29).
- Younger treatment initiation and lower baseline IGF-1 SDS significantly predicted a more robust response.
Why it matters
The pooled comparisons indicate that growth response to rhGH differs across these pediatric indications, with the strongest response reported in complete GHD. The findings also identify age at treatment initiation and baseline IGF-1 SDS as response predictors. These distinctions can inform interpretation of expected growth outcomes and support consideration of patient characteristics when evaluating treatment response.
What to keep in mind
The review pooled studies with differing designs and assessed study quality using multiple tools; the abstract does not report the extent of between-study heterogeneity.