Cystic Fibrosis Clinical Trial
Official title:
GROWTH HORMONE USE IN CYSTIC FIBROSIS - A MULTICENTER STUDY
Cystic fibrosis (CF) is a catabolic condition, and children affected with this disease frequently have problems with growth, despite adequate nutrition. We hypothesize that the anabolic effects of growth hormone (GH) will improve the height and weight of CF patients and thereby improve their clinical status and their quality of life. We further hypothesize that these effects will be sustained for at least one year after GH treatment is complete.
We will test our hypotheses by recruiting 40 CF children from five CF centers (8 per center)
across the country. Patients will be randomly assigned to receive treatment with GH (0.3
mg/kg/wk) during the first 12 months, or during the second 12 months. All subjects will be
followed every three months for the entire 24 months. Growth data and PFT data from the year
prior to study will be obtained from the medical record for each subject. Our specific aims
include:
1. To determine the effect of GH on height, height velocity, body weight and lean body
mass. We will measure height and weight using a standardized stadiometer and scale,
respectively, every three months during the study. From these measurements we will
calculate height and weight velocity and height and weight Z score. Lean body mass (LBM)
will be measured by DEXA every six months. Baseline height and weight will be analyzed
as covariates to determine whether children whose height and/or weight are at the lowest
percentiles achieve greater improvement in height and weight velocity and lean body
mass. This specific aim tests the hypothesis that GH significantly improves height,
height velocity, weight, weight velocity and lean body mass in CF children irrespective
of growth prior to starting the drug.
2. To determine the effect of GH on pulmonary function. Pulmonary function tests, including
FEV1, FVC and PImax and PEmax (for estimation of respiratory muscle strength), will be
measured at baseline and every 6 months in all subjects. We will document inpatient
admissions and outpatient antibiotic therapy during the study. Baseline pulmonary
function will be analyzed as a covariate to determine whether children with good
pulmonary function achieve greater benefit than children with poor pulmonary function.
This specific aim tests the hypothesis that GH use improves pulmonary function in CF
children regardless of level of pulmonary functions prior to using the drug.
3. To determine if GH use in CF patients positively impacts quality of life. At baseline
and every six months, we will administer a 15 minute questionnaire to both the parent
and patient to assess quality of life. These questionnaires entitled "The Cystic
Fibrosis Questionnaire" have been recently developed and tested for quality. They are
specific for CF patients and have been approved by the National CF Foundation. This
specific aim will test the hypothesis that GH use improves quality of life in CF
patients.
4. To determine if the clinical improvement obtained from GH use is sustained. Those
patients treated with GH during the first 12 months will be followed for 12 months after
treatment to determine if the outcome variables remain better than baseline after growth
hormone therapy is discontinued. This specific aim tests the hypothesis that GH use
results in sustained improvement in height velocity, weight velocity, lean body mass,
pulmonary function and quality of life.
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