ESPE Abstracts

Objectives: Recently, aromatase inhibitors are increasingly prescribed as an alternative off-label therapy for short stature in boys, yet its efficiency is controversial. This study aimed to evaluate the effect of aromatase inhibitors on the treatment of short statured boys in adolescence by a comprehensive meta-analysis of published randomized controlled trials.

Methods: Literature search, quality assessment and data extraction were completed independently and in duplicate. Statistical analysis was completed using the STATA software. Effect-size estimates are expressed as weighted mean difference (WMD) with 95% confidence interval (CI).

Results: Seven randomized controlled trials including 265 short statured adolescent boys are eligible for analysis. Overall analysis showed that changes in predictive adult height were greater in the intervention arm than in the control arm (WMD: 3.42 cm; 95% CI: 0.76 to 6.09; p: 0.012), as well as in final height (WMD: 3.49 cm; 95% CI: 0.89 to 6.09; p: 0.009), final height standard deviation score (WMD: 0.46; 95% CI: 0.19 to 0.74; p: 0.001), height gain (WMD: 4.22 cm; 95% CI: 0.46 to 1.25; p: 0.005) and height standard deviation score for bone age (WMD: 0.86; 95% CI: 0.46 to 1.25; p <0.001). In contrast, bone age progression in the treatment arm was significantly slower than that in the control arm (WMD: -1.01 years; 95% CI: -1.71 to 0.74; p: 0.005). Meta-regression analysis indicated that treatment interval and trial quality were possible causes of heterogeneity (p <0.05). There was a low probability of publication bias as reflected by Egger's tests.

Conclusions: This meta-analysis provides evidence for the effectiveness of aromatase inhibitors in the treatment of adolescent boys struggling with short stature. Despite the optimism that aromatase inhibitors are effective in gaining an obvious height increase, clinical application of aromatase inhibitors in pediatrics is still largely pending reproducible clinical investigations on the challenge to tailor optimal pharmacologic dosage and treatment interval for the best possible outcomes for short statured boys in adolescence.