Reversal of Growth Arrest with the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children

Details

• Alternative Title:
  Ann Surg
• Personal Author:
  Herndon, David N. ; Voigt, Charles D. ; Capek, Karel D. ; Wurzer, Paul ; Guillory, Ashley ; Kline, Andrea ; Andersen, Clark R. ; Klein, Gordon L. ; Tompkins, Ronald G. ; Suman, Oscar E. ; Finnerty, Celeste C. ; Meyer, Walter ; Sousse, Linda E.
• Description:
  Background
  
  The hypercatabolic response in severely burned pediatric patients is associated with increased production of catecholamines and corticosteroids, decreased formation of testosterone, and reduced strength alongside growth arrest for up to 2 years post injury. We have previously shown that, in the pediatric burned population, the administration of the testosterone analog oxandrolone improves lean body mass accretion and bone mineral content and that the administration of the β1, β2 adrenoreceptor antagonist propranolol decreases cardiac work and resting energy expenditure while increasing peripheral lean mass. Here, we determined whether the combined administration of oxandrolone and propranolol has added benefit.
  
  Methods
  
  In this prospective, randomized study of 612 burned children (52 ± 1% of total body surface area burned, ages 0.5–14 years [males]; ages 0.5–12 years [females]), we compared controls to the individual administration of these drugs, and the combined administration of oxandrolone and propranolol at the same doses, for 1 year post burn. Data were recorded at discharge, 6 months, and 1 and 2 years post injury.
  
  Results
  
  Combined use of oxandrolone and propranolol shortened the period of growth arrest by 84 days (p=0.0125 vs. control) and increased growth rate by 1.7 cm/y (p=0.0024 vs. control).
  
  Conclusion
  
  Combined administration of oxandrolone and propranolol attenuates burn-induced growth arrest in pediatric burn patients. This study is registered at clinicaltrials.gov: NCT00675714 and NCT00239668. Growth Arrest and Growth Rate By Treatment GroupTreatmentLength of Growth Arrest(Days)Growth Rate(cm/y)Control280 ± 195.9 ± 0.2Oxandrolone217 ± 175.8 ± 0.3Propranolol242 ± 136.3 ± 0.2Oxandrolone + Propranolol196 ± 15*7.6 ± 0.5*Data presented as mean ± standard error.*p<0.05 vs. control.
  
  
• Subjects:
  Adolescent Burns Child Child, Preschool Drug Therapy, Combination Female Growth Growth Disorders Humans Infant Male Oxandrolone Propranolol Prospective Studies Testosterone

  More +
• Source:
  Ann Surg. 264(3):421-428.
• Pubmed ID:
  27433905
• Pubmed Central ID:
  PMC5167626
• Document Type:
  Journal Article
• Funding:
  R01 HD049471/HD/NICHD NIH HHS/United States ; R01 GM112936/GM/NIGMS NIH HHS/United States ; U48 DP000043/DP/NCCDPHP CDC HHS/United States ; R01 GM056687/GM/NIGMS NIH HHS/United States ; P50 GM060338/GM/NIGMS NIH HHS/United States ; T32 GM008256/GM/NIGMS NIH HHS/United States ; UL1 TR001439/TR/NCATS NIH HHS/United States
• Volume:
  264
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7734b9d05d47953d6be660dc99d2e57ee236121f9d2ea0a52fe6ee9791dce66d
• Download URL:
  https://stacks.cdc.gov/view/cdc/43295/cdc_43295_DS1.pdf
• File Type:
  [PDF - 1.41 MB ]