| Research BackgroundThe prevalence of central precocious puberty(CPP)is increasing worldwide,and the early onset of secondary sexual characteristics in children is a threat to their physical and mental health.Therefore,CPP treatment has attracted widespread attention from the society.Gonadotropin-releasing hormone analogs(GnRHa)have been used primarily in the treatment of CPP.The 1-or 3-monthly depot is a suitable alternative for CPP.The 3-monthly GnRHa was clinically available in 2020 for the treatment of CPP in China.It can reduce the number of injections and visits to the doctor,and reduce physical and psychological pain for children with CPP.Patients also have the freedom to choose to use the 1-or 3-monthly depot according to their wishes.The 1-month depot have been used successfully in China to suppress the progression of bone age and improve adult height of CPP children,while the clinical experience of the 3-month depot is limited in China due to the lately availability in China.ObjectiveTo compare the efficacy of GnRHa in the 3-month and 1-month depot,monitor luteinizing hormone(LH)and follicle stimulating hormone(FSH)to assess hypothalamic pituitary gonadal axis suppression,monitor height,weight,bone age and predict adult height to assess physical Growth and development.The efficacy of two formulations and different methods of administration were compared.MethodsGirls diagnosed with CPP in the Department of Pediatric Endocrinology,Bao’an People’s Hospital,Shenzhen,from 09/2020 to 02/2022 who meet the GnRHa administration criteria were enrolled and divided into 3 groups according to different treatment regimens:the group receiving 3.75 mg 1monthly leuprorelin or triptorelin,the group receiving 11.25 mg 3-monthly leuprorelin and the group switch between short-acting and long-acting GnRHa.Follow up every 3 months for a total of 1 year.LH and FSH levels,anthropometric data were monitored every 3 months,bone age,predicted adult height was reviewed every 6 months to compare the efficacy of the three groups.Results(1)A total of 47 subjects were included in this study.There were 26 girls in the short-acting group,9 in the long-acting group and 12 in the switching group.There were no statistical differences in serum basal LH and FSH levels,anthropometric data and bone age and difference between bone age and chronological age among this three groups before GnRHa treatment(all P>0.05).(2)The suppression in basal LH and FSH levels was statistically significant in each group after 1 year of treatment(all P<0.05),and there was no statistical difference in the comparison among the three groups(P>0.05).(3)Height SDSBA in the short-acting,long-acting and switching groups respectively increased from(-0.85 ± 0.71),(-1.04 ±0.86)and(-0.76± 0.87)at baseline to(-0.40 ± 0.75),(-0.29 ± 1.03)and(-0.39 ± 0.97)after 1 year of treatment(all P<0.05).No statistical difference in weight SDS between the three groups before and after treatment(P>0.05).(4)Predicted adult height in the shortacting,long-acting and switching groups respectively increased from(154.54 ± 4.98)cm,(152.51±7.14)cm and(155.45 ± 5.94)cm at baseline to(157.64±5.42)cm,(158.66 ± 7.15)cm and(157.75 ± 6.75)cm after 1 year of treatment(all P<0.05).The increase in predicted adult height was(2.85±1.20)cm greater in the long-acting group than in the short-acting group,and was(3.35±1.37)cm greater in the longacting group than in the switching group(P<0.05).(5)After 1 year of treatment,the difference between bone age and chronological age was reduced and bone age progression was slow down in the short-acting,long-acting and switching groups(all P<0.05).(6)63.83%of patients would prefer the 3-monthly depot and 36.17%would prefer the 1-monthly depot.Conclusion3-month and 1-month GnRHa depot are equally effective in suppressing the hypothalamic-pituitary-gonadal axis,delaying the progression of bone age,increasing predicted adult height and not causing obesity.The 3-month depot are more effective in increasing the increase in PAH.The switching between 1-monthly and 3-monthly formulation do not affect either gonadal suppression or the delay of bone age progression.The 1-monthly depot and 3monthly depot can be used in clinical practice.Most children and their parents prefer to use the 3-monthly depot due to the less numbers of visits and injections. |
