Background: Although GHs safety profile since 1987 is good, concerns remain regarding cancer (CA) risk, and French SAGhE data indicated increased mortality and cerebrovascular disease (CVD) in certain GH-treated patients (pts).
Objective and hypotheses: To evaluate key safety outcome incidence in GH-treated pts of all short stature diagnoses (dx) who participated in GeNeSIS (19992015, 30 countries).
Methods: Pt history/case ascertainment required review of study and corporate pharmacovigilance databases. Person-years (PY) of follow-up were calculated between first and last contacts (later of event onset, last study visit or summary date). Standardised mortality (SMR) and incidence (SIR) ratios were calculated using expected cases from contemporary general population registries (CDC, GLOBOCAN, SEER, SEARCH for Diabetes in Youth, WHO) adjusted for country, age, sex and ethnicity (where applicable).
Results: Amongst 21178 pts eligible for analysis the predominant short stature dx were GH deficiency (63%), idiopathic short stature (13%), Turner syndrome (8%) and small for gestational age (6%). Mean±SD study entry age was 10.5±3.8Y and duration of follow-up was 4.4±3.2Y (~92,000PY). The table shows cases, crude incidence and SMR/SIR for key outcomes. SMRs were not elevated for any specific dx except for pts with organic GH deficiency due to previous (prev) CA (SIR, 95%CI 5.87, 3.219.85). Most pts with incident type 2 diabetes (T2DM) had risk factors (incl. syndromic dx, prev irradiation, obesity). Haemorrhagic CVD occurred in 2 intracranial tumour (ICT) survivors and after renal transplant in 1 pt with renal insufficiency.
|Outcome||Pts at risk||N affected/N at risk (%)||Affected/1000 PY, 95% CI||SMR/SIR, 95% CI|
|Any event||All||6365/21178 (30.1)|||||
|Death||All||42/21178 (0.20)||0.46, 0.340.62||0.61, 0.440.82|
|CVD||All||16/21178 (0.08)||0.17, 0.110.28|||
|Haemorrhagic||All||3/21178 (0.01)||0.03, 0.010.10|||
|T2DM||All||18/21178 (0.08)||0.20, 0.120.31||3.79, 2.256.00|
|1st CA||No prev CA||14/20556 (0.07)||0.16, 0.090.27||0.71, 0.391.20|
|ICT recurrence||Prev ICT||67/823 (8.14)||16.9, 13.321.5|||
|2nd neoplasm||Prev CA||31/622 (4.98)||10.7, 7.515.2|||
Conclusion: Acknowledging the limited GeNeSIS follow-up duration, no increased risk for death or 1st CA was observed, and no strokes were recorded in dx studied in published SAGhE analyses. SIRs for T2DM were elevated so glucose monitoring of GH-treated pts with risk factors is recommended. All pts with prev ICT/CA should be monitored for recurrence/2nd neoplasm whether treated or not with GH.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology