ESPE2018 Poster Presentations GH & IGFs P2 (33 abstracts)
The BSPED National GH Audit: Trends in Prescribing from 2013–2016
Leena Patel a , Sheila Shepherd b , Nick Shaw c & Vrinda Saraff c
aThe University of Manchester, Hon Consultant Paediatric Endocrinologist, Royal Manchester Children’s Hospital, Manchester, UK; bUniversity of Glasgow, Glasgow, UK; cUniversity of Birmingham, Birmingham, UK
Introduction: Prescribing of recombinant human GH for growth failure in UK children is based on guidance from the National Institute of Clinical Excellence. In 2013, the BSPED initiated this national audit of children/adolescents newly-prescribed GH to monitor trends in NHS prescribing practice. Here we have examined these trends from 2013 to 2016.
Patient population: All patients aged ≤16.0 years newly starting GH therapy in the UK.
Methods: Anonymised data provided by NHS consultants who initiate GH treatment was analysed for diagnostic indication and age at treatment start.
Results: Of 85 centres, 76 submitted data (89%). Table 1 shows number of patients starting GH for licensed (GH deficiency (GHD), born small for gestational age (SGA), Turner syndrome (TS), Prader–Willi syndrome (PWS), chronic renal insufficiency (CRI) and SHOX deficiency). Off-license prescribing includes idiopathic short stature, genetic syndromes, chronic inflammatory conditions and low IGF1/GH resistance. Table 2 shows age treatment started.
| Year | GHD | Turner | PWS | CRI | SGA | SHOX | Off license | Total |
| 2013 | 536 (55) | 85 (9) | 61 (6) | 35 (4) | 144 (15) | 10 (1) | 94 (10) | 966 |
| 2014 | 537 (56) | 104 (11) | 53 (6) | 24 (3) | 150 (16) | 20 (2) | 65 (7) | 944 |
| 2015 | 481 (56) | 85 (10) | 50 (6) | 22 (3) | 149 (17) | 15 (2) | 53 (6) | 856 |
| 2016 | 559 (57) | 98 (10) | 50 (5) | 23 (2) | 177 (18) | 25 (3) | 51 (5) | 983 |
| Year | GHD | Turner | PWS | CRI | SGA | SHOX | Off license |
| 2013 | 8.5 | 8.4 | 2.6 | 9.8 | 6.1 | 8.8 | 8.6 |
| (0.1–16) | (1.3–15.4) | (0.3–13.5) | (1.5–15.6) | (1.5–14.8) | (2.2–15) | (1.4–15.7) | |
| 2014 | 8.6 | 5.9 | 2.3 | 7.6 | 6.3 | 8.7 | 9.5 |
| (0.1–16) | (2.5–16) | (0.3–13.9) | (1–12.2) | (1.7–15.3) | (2.5–14.7) | (2.4–15.8) | |
| 2015 | 8.7 | 7.4 | 1.9 | 10.7 | 6.1 | 9.7 | 9.1 |
| (0.1–16) | (2.1–15.4) | (0.2–15.1) | (2.3–15.1) | (1.3–14.7) | (2.8–13.4) | (3.6–15.6) | |
| 2016 | 8.2 | 6.7 | 2.0 | 8.2 | 6.3 | 7.8 | 9.3 |
| (0.1–15.9) | (1.8–15.9) | (0.2–11.7) | (1.8–15) | (1.8–15.6) | (1.6–14.6) | (1.8–15.3) | |
| 2013 | 8.5 | 7.3 | 2.2 | 9.0 | 6.2 | 8.7 | 9.2 |
| −16 | (0.1–16) | (1.3–16)*3 | (0.2–15.1)*1 | (1.0–15.6) | (1.3–15.6)*2 | (1.6–15) | (1.4–15.8) |
| *1PWS younger than other groups (P<0.0001). *2SGA younger than all except PWS (P<0.0001). *3TS younger than GHD (P=0.035). | |||||||
Conclusion: Off-license prescribing has declined by half in this 4 year period. Compared to other indications, GH is initiated at a significantly younger age in children with PWS, followed by SGA. Reference: NICE 2010 TA188. Human GH (somatropin) for the treatment of growth failure in children. https://www.nice.org.uk/guidance/ta188/chapter/1-Guidance
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