A gonadotropin-releasing hormone analogue (GNRHA) is a synthetic gonadotropin-releasing hormone. gnRHA is the preferred and standard drug for central precocious puberty, which has a definite effect on central precocious puberty, can effectively inhibit the early active gonadal axis, and delay menarche;At the same time, the skeletal maturation of children with central precocious puberty is delayed, so as to achieve the goal of improving the final adult height of children. However, many parents have some doubts about the dosage form of gnRHA, when to take the drug, and the specific medication schedule. Today, I will take you to take a look at these questions in detail!
no.1: The Great Exploration of GNRHA Dosage Forms.
Several drugs commonly used in clinical practice include triptorelin, leuprolide, buserelin, goserelin, and histaminelin, which are 15 200 times more effective than natural GNRH [1].
There are currently 375 mg of extended-release (intramuscular or subcutaneous injection every 4 weeks) and 1125mg of long-acting sustained-release agent (injected once every 12 weeks), there are still 22 abroad5mg, 30mg, and 50mg extended-release or subcutaneous implant preparations. Among them, the domestic with 3Triptorelin and leuprolide 75 mg preparations are most commonly used[1]. In addition, patients with central precocious puberty require adequate doses of gnRHA**. Therefore, no matter what dosage form and which drug is chosen, it must be used correctly under the guidance of a doctor.
no.2: The time of GNRHA medication is revealed.
01 At the beginning, most parents will ask: When is the best time to start using GNRHA?In fact, some guidelines recommend that the best height benefit may be achieved in girls with central precocious puberty before the age of six years with GNRHA [1,2], while remedication in girls over eight years of age may be too late and the benefit in terms of height is not significant [3]. However, in the actual clinical process, the application of GNRHA should follow the principle of individualization, and there is no uniform requirement for the time of starting, according to the specific situation of the child.
02 Time to stop the drug.
There is also a lack of a fixed standard for the duration of discontinuation of GNRHA, which should be no less than two years to achieve the goal of maximizing height improvement [1].
In general, discontinuation of the drug can be considered when the bone age is the same as the age and the normal developmental age is at or near the age of normal sexual development, and the height is slightly higher than the target height (generally 2 3 cm taller). Or in girls with a bone age greater than 12At the age of 5, the boy's bone age is greater than 14 years old, and the drug is discontinued, because the epiphysis is close to closure at this time, even if the combined use of growth hormone can not play a role in improving lifelong height. In addition, the specific timing of drug discontinuation is determined by factors such as the wishes, compliance, and quality of life of the child and the parent [2]. It is important to note that individual poorly controlled patients may require shortened intervals or exceeding standard doses, and this process must be done with caution and attention to monitoring and evaluation at all times [1].
03 Review time during the period:
After about 3 months of application of gnRHA, remember to take the child for a re-examination, ** height, check the control of sexual development, and check the level of sex hormones. In addition, according to the guidelines for precocious puberty, bone age and gonadal ultrasound should be repeated about 6 months after the application of GNRHA.
no.3: GNRHA medication regimen:
There is also a lack of unified standards for the medication regimen and specific dosage of GNRHA at home and abroad. In 2015, the consensus of central precocious puberty diagnosis and ** in China recommended administration by kilogram body weight [1]: the first dose of 375 mg, thereafter at a dose of 80 100 g (kg/4 weeks);or at the usual dose of 375 mg, injected once every 4 weeks. The maintenance dose is individualized and can be adjusted appropriately according to gonadal axis function inhibition. However, dosage options may vary depending on the drug formulation. The dosing dose of triptorelin has been reported in the literature to be 60 160 g (kg/4 weeks);Leuprolide** doses range from 30 to 180 g (kg/4 weeks) and can even reach up to 350 g (kg/4 weeks)[1].
In the 2019 GNRHA International Expert Consensus [2], leuprolide dosage is standardized in Europe and Asia.375 mg every 4 weeks, weight-based doses are no longer recommended for leuprolide acetate;The starting dose of triptorelin is usually 375 mg, with a gradual increase to 11 if necessary25 mg。
Written at the end of the dear parents, although GNRHA is the first choice for central precocious puberty in children, it must be used cautiously under the guidance and advice of the doctor, after all, each child is unique, and the regimen of drug use is of course different, and the doctor will definitely choose the most suitable plan for your child.