Endocrine Abstracts

Background: Adult growth hormone deficiency (AGHD) has been increasingly observed among patients with traumatic brain injury, stroke, and central nervous system infection, aside from the subgroup of patients with pituitary tumors. When left untreated, these patients have a significantly increased risk to develop cardiovascular morbidity and mortality and impaired psychosocial function. Existing treatment guidelines on AGHD have recommended the use of growth hormone (GH) replacement as the gold standard, of treatment, requiring daily GH injections, which can be burdensome and costly for patients. More recently, however, a novel drug Somapacitan (Novo Nordisk A/S, Denmark), was investigated in a number of small randomized controlled trials as an effective long-acting form of GH replacement therapy. It acts as a reversible albumin-binding GH derivative, thereby increasing its half-life and reducing its clearance from the body. Despite this discovery, on the other hand, there is no existing meta-analysis to create a more robust conclusion regarding its safety and efficacy.

Objective: This metaanalysis aims to evaluate the overall safety and efficacy of weekly somapacitan versus once daily growth hormone in adults with growth hormone deficiency (AGHD). Specific outcomes that were compared between weekly somapacitan and daily GH injections were the incidence of adverse effects, local tolerability, convenience scores of participants, and mean IGF-1 levels.

Methods: A comprehensive search of literature was done through electronic databases (Pubmed, MEDLINE, Cochrane Library) until December 1, 2022. The study included only phase 3 randomized controlled trials (RCTs) which were directed towards the adult population. RevMan 5.4 was utilized to analyze the efficacy and safety of weekly somapacitan versus daily growth hormone replacement.

Results and analysis: Three RCTs were included with a total of 415 participants. The incidence of adverse events including local injection-related reactions with weekly somapacitan as well as their mean IGF-1 levels were comparable to daily growth hormone injections but had better convenience scores, therefore increasing adherence to treatment which results to better quality of life.

Conclusion: Adherence to treatment plays an important role in improving treatment outcomes in patients with AGHD. With that, once weekly somapacitan can be offered as a safe and well-tolerated alternative to daily growth hormone injections among adults with growth hormone deficiency. This pilot meta-analysis was able to show the efficacy and safety of somapacitan versus the current standard, making it a promising treatment option to adults with growth hormone deficiency which can improve treatment compliance from childhood to adulthood.