Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States

Jadranka Popovic; Mitchell E Geffner; Alan D Rogol; Lawrence A Silverman; Paul B Kaplowitz; Nelly Mauras; Philip Zeitler; Erica A Eugster; Karen O Klein

doi:10.3389/fped.2022.968485

Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States

Front Pediatr. 2022 Oct 4:10:968485. doi: 10.3389/fped.2022.968485. eCollection 2022.

Authors

Jadranka Popovic¹, Mitchell E Geffner², Alan D Rogol³, Lawrence A Silverman⁴, Paul B Kaplowitz⁵, Nelly Mauras⁶, Philip Zeitler⁷, Erica A Eugster⁸, Karen O Klein⁹

Affiliations

¹ Department of Pediatric Endocrinology, Pediatric Institute, Allegheny Health Network, Pittsburgh, PA, United States.
² Department of Pediatric Endocrinology, Diabetes and Metabolism, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
³ Department of Pediatric Diabetes and Endocrinology, University of Virginia, Charlottesville, VA, United States.
⁴ Department of Pediatric Endocrinology, Goryeb Children's Hospital Atlantic Health, Morristown, NJ, United States.
⁵ Department of Endocrinology, Children's National Hospital, Washington, DC, United States.
⁶ Department of Pediatrics, Nemours Children's Health System, Jacksonville, FL, United States.
⁷ Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States.
⁸ Department of Pediatric Endocrinology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States.
⁹ Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States.

Abstract

Gonadotropin-releasing hormone agonists (GnRHa's) are the standard treatment for children with central precocious puberty (CPP). We aim to present data on available GnRHa options with an easy-to-review table and discuss factors that influence treatment selection. Five GnRHa's are currently FDA-approved and prescribed in the US and published data suggest similar safety and efficacy profiles over the first year of treatment. One- and 3-month intramuscular (IM) leuprolide acetate (LA) have long-term safety and efficacy data and allow for flexible dosing. Six-month IM triptorelin pamoate offers a longer duration of treatment, but without long-term efficacy and outcome data. Six-month subcutaneous (SQ) LA combines a SQ route of injection and long duration of action but lacks long-term efficacy and outcome data. The 12-month SQ histrelin acetate implant avoids injections and offers the longest duration of action, but requires a minor surgical procedure with local or general anesthesia. Factors in treatment selection include route of administration, needle size, injection volume, duration of action, and cost. The current GnRHa landscape provides options with varying benefits and risks, allowing physicians and caregivers to select the most appropriate therapy based on the specific needs and concerns of the child and the caregiver. Agents have different advantages and disadvantages for use, with no one agent displaying superiority.

Keywords: central precocious puberty (CPP); gonadotropin-releasing hormone (GnRH) agonists; histrelin acetate; leuprolide acetate; triptorelin pamoate.

Publication types

Review