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Cochrane Database of Systematic Reviews

Tratamiento con hormona del crecimiento para pacientes con talasemia

Esta versión no es la más reciente

ver la versión actual 28 mayo 2020

Información

DOI:
https://doi.org/10.1002/14651858.CD012284.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 18 septiembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Fibrosis quística y enfermedades genéticas

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Chin Fang Ngim

    Correspondencia a: Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia

    [email protected]

  • Nai Ming Lai

    School of Medicine, Taylor's University, Subang Jaya, Malaysia

  • Janet YH Hong

    Department of Paediatrics, Putrajaya Hospital, Putrajaya, Malaysia

  • Shir Ley Tan

    HPS Pharmacies, Calvary North Adelaide Hospital, Adelaide, Australia

  • Amutha Ramadas

    Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Malaysia

  • Premala Muthukumarasamy

    Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia

  • Meow‐Keong Thong

    Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia

Contributions of authors

MKT, NML and CFN conceived the review title and developed the search strategy

CFN, SLT, AR and NML participated in screening, selection, data extraction, risk of bias assessment and data entering via Covidence.

NML developed the SOF table using GDT GRADEPRO.

CFN wrote the first draft of the review. All authors participated in revising the draft review and approved the final version.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute for Health Research, UK.

    This systematic review was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group.

Declarations of interest

JH received a honorarium for giving a talk in an event sponsored by a pharmaceutical company related to growth hormone.

CFN, NML, SLT, AR, PM and MKT have no conflict of interest to declare.

Acknowledgements

We thank the Cochrane Cystic Fibrosis and Genetic Disorders Review Group, especially the Managing Editors, Tracey Remmington and Nikki Jahnke in the development of this review. We also thank the review group editors and referees for their comments on our draft review.

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2020 May 28

Growth hormone therapy for people with thalassaemia

Review

Chin Fang Ngim, Nai Ming Lai, Janet YH Hong, Shir Ley Tan, Amutha Ramadas, Premala Muthukumarasamy, Meow-Keong Thong

https://doi.org/10.1002/14651858.CD012284.pub3

2017 Sep 18

Growth hormone therapy for people with thalassaemia

Review

Chin Fang Ngim, Nai Ming Lai, Janet YH Hong, Shir Ley Tan, Amutha Ramadas, Premala Muthukumarasamy, Meow‐Keong Thong

https://doi.org/10.1002/14651858.CD012284.pub2

2016 Jul 15

Growth hormone therapy for people with thalassaemia

Protocol

Chin Fang Ngim, Nai Ming Lai, Janet Y Hong, Shir Ley Tan, Amutha Ramadas, Premala Muthukumarasamy, Meow‐Keong Thong

https://doi.org/10.1002/14651858.CD012284

Differences between protocol and review

A secondary outcome of 'Serum insulin‐like growth hormone (IGF‐1)' was added in agreement with the input by a peer reviewer that this outcome has additional value in assessing response to GH therapy.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Child; Female; Humans; Male;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Comparison 1 Growth hormone versus control, Outcome 1 Oral glucose tolerance test sum (mg/dL).
Figuras y tablas -
Analysis 1.1

Comparison 1 Growth hormone versus control, Outcome 1 Oral glucose tolerance test sum (mg/dL).

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Comparison 1 Growth hormone versus control, Outcome 2 Fasting blood glucose (mg/dL).
Figuras y tablas -
Analysis 1.2

Comparison 1 Growth hormone versus control, Outcome 2 Fasting blood glucose (mg/dL).

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Comparison 1 Growth hormone versus control, Outcome 3 Height SD score.
Figuras y tablas -
Analysis 1.3

Comparison 1 Growth hormone versus control, Outcome 3 Height SD score.

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Comparison 1 Growth hormone versus control, Outcome 4 Change from baseline in height SD score.
Figuras y tablas -
Analysis 1.4

Comparison 1 Growth hormone versus control, Outcome 4 Change from baseline in height SD score.

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Comparison 1 Growth hormone versus control, Outcome 5 Height velocity (cm/year).
Figuras y tablas -
Analysis 1.5

Comparison 1 Growth hormone versus control, Outcome 5 Height velocity (cm/year).

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Comparison 1 Growth hormone versus control, Outcome 6 Height velocity SD score.
Figuras y tablas -
Analysis 1.6

Comparison 1 Growth hormone versus control, Outcome 6 Height velocity SD score.

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Comparison 1 Growth hormone versus control, Outcome 7 Change from baseline in height velocity SD score.
Figuras y tablas -
Analysis 1.7

Comparison 1 Growth hormone versus control, Outcome 7 Change from baseline in height velocity SD score.

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Comparison 1 Growth hormone versus control, Outcome 8 Serum insulin‐like growth hormone (IGF‐1) (ng/mL).
Figuras y tablas -
Analysis 1.8

Comparison 1 Growth hormone versus control, Outcome 8 Serum insulin‐like growth hormone (IGF‐1) (ng/mL).

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Summary of findings for the main comparison. Growth hormone for people with thalassaemia

Growth hormone for people with thalassaemia

Patient or population: people with thalassaemia (any age)
Setting: any
Intervention: growth hormone therapy
Comparison: no growth hormone or standard care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with growth hormone

Final height and change in height

The included trial did not assess either of these outcomes.

Adverse effects

Oral glucose tolerance test (mg/dL)

(at one year)

The mean oral glucose tolerance test was 336.56 mg/dL.

MD 0.03 lower

(17.45 lower to 17.39 higher).

‐

20
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

Fasting blood glucose levels in the growth hormone group were significantly higher than in the control group but both were still within the normal range.

Height SDS
(at one year)

The mean height SDS was ‐2.85.

MD 0.09 lower
(0.33 lower to 0.15 higher).

‐

20
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

Change in height SDS

(difference between baseline and final visit at one year)

The change in mean height SDS was ‐0.05.

MD 0.26 higher
(0.13 higher to 0.39 higher).

‐

20
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

Height velocity

(cm/year)

The mean height velocity was 3.99 cm/year.

MD 2.28 higher
(1.76 higher to 2.8 higher).

‐

20
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

Height velocity SDS

The mean height velocity SDS was ‐1.56.

MD 3.31 higher
(2.43 higher to 4.19 higher).

‐

20
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

Change in height velocity SDS (difference between baseline and final visit at one year)

The change in mean height velocity SDS was 1.76.

MD 3.41 higher
(2.45 higher to 4.37 higher).

‐

20
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; SDS: standard deviation score

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

1 Data contributed by a single trial with small sample and 95% CI is wide.

Figuras y tablas -
Summary of findings for the main comparison. Growth hormone for people with thalassaemia
Ir a la tabla de la revisión
Comparison 1. Growth hormone versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Oral glucose tolerance test sum (mg/dL) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Fasting blood glucose (mg/dL) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Height SD score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Change from baseline in height SD score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Height velocity (cm/year) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Height velocity SD score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Change from baseline in height velocity SD score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Serum insulin‐like growth hormone (IGF‐1) (ng/mL) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

8.1 At one year

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 1. Growth hormone versus control
Ir a la tabla de la revisión