Abstract Background INSIGHTS-GHT is a German nationwide, product-independent registry endorsed by scientific societies that captures real-world use of growth hormone (GH) therapies in both children and adults, including long-acting GH (LAGH). LAGH reduces injection frequency and may improve adherence in replacement therapy for growth hormone deficiency (GHD). We present updated baseline utilisation and treatment patterns in paediatric/adolescent and adult patients initiating LAGH. Methods This interim cross-sectional analysis included registry patients with GHD who initiated LAGH from 2023 onwards. Demographics, prior GH exposure, starting dose at LAGH initiation (categorised relative to product label), and baseline IGF-I/IGFBP-3 were summarised by age group. Results At database analysis on December 3rd, 2025, 2218 patients were enrolled into the register study, 191 of whom received LAGH preparations. Paediatric/Adolescent Cohort Among 114 patients aged <18 years initiating LAGH, mean age at initiation was 9.5 ± 3.8 years; 77.2% were male and 74.5% were prepubertal. Fifty-eight percent switched from daily GH (median prior duration 2.9 years). At initiation, 80.6% received a starting dose below the product-label recommendation; the median dose was 92% of the recommended dose. In switch patients, IGF-I SDS was −2.1 (SD 1.2) before any GH and 0.1 (SD 1.6) at LAGH initiation. Adult Cohort Seventy-two adults initiated somapacitan treatment, the only approved LAGH for the adult indication in Germany at the time. Mean age at initiation was 42.4 (SD 16.2) years; 55.6% were male. Most patients (90.1%) had organic GHD, and 45.5% had childhood-onset disease. Ninety-one percent switched from daily GH (median prior duration 10.7 years). Starting dose relative to label was below in 39.3%, in label in 53.6%, and above in 7.1%; mean dose was 87.9% (SD 30.2) of the recommended dose (median 100%; range 30%-200%). No new safety signals were detected in either cohort. Registry data contribute to post-authorisation safety (PASS) requirements. Conclusions In routine practice, LAGH is commonly initiated with conservative starting doses relative to product labels in both paediatric/adolescent and adult patients, suggesting cautious titration during early adoption. Longitudinal follow-up in INSIGHTS-GHT will assess how these initial dosing strategies translate into IGF-I trajectories, effectiveness, adherence, and safety under real-world conditions.
Background Replacement therapy with recombinant human PTH (rhPTH1-84) represents a causal treatment for patients with chronic hypoparathyroidism (HypoPT). Recently, palopegteriparatide (TransCon PTH), a novel long-acting drug with slow release of PTH1-34, was approved by the European Medicines Agency and Food and Drug Administration for treatment of HypoPT. To date, no data exist on the treatment switch from rhPTH1-84 to TransCon PTH. Methods We retrospectively analyzed clinical data from 40 patients with chronic HypoPT during the switch from rhPTH1-84 to TransCon PTH. Independent of the last prior rhPTH1-84 dose, all patients were started on 18 µg of TransCon PTH as recommended by the manufacturer. TransCon PTH dose adjustments, changes in additional medication, and adverse events were documented during the treatment switch. Results Within the first month after the treatment switch, 80% (n = 32) of patients needed individual adjustment of their TransCon PTH dose to achieve normocalcemia. Dose reduction (to 9-15 µg) was necessary in 38% (n = 15) and an increase (to 21-27 µg) in 43% (n = 17) of patients. Adjustments occurred predominantly (in 62% cases) according to serum calcium levels, partly dependent on symptoms. The prior applied rhPTH1-84 dose correlated significantly with the adjusted TransCon PTH dose (r = 0.4; P = .01). The treatment change was associated with moderate or mild adverse events in 24/40 patients. Conclusion We hereby report the first clinical data on switching treatment from rhPTH1-84 to 18 µg TransCon PTH independent of the prior rhPTH1-84 dose. Our data support discrete adaptation of the starting dose depending on the prior rhPTH1-84 dosage.
The role of uric acid (UA) on bone metabolism is controversially discussed. Higher UA levels have been associated with higher T-scores and a reduced incidence of fractures in postmenopausal women. However, in the context of rheumatoid arthritis (RA), the role of UA remains unclear. This pilot study aimed to investigate the association of UA levels with bone mineral density in RA female and male patients. This pilot study analyzed patients with RA to explore preliminary associations. We utilized data from the Rh-GIOP cohort, a prospective monocentric observational study focusing on bone health in chronic rheumatic diseases. To assess the association between UA levels and the lowest T-scores measured at the lumbar spine, hip, or femur, we used linear regression with adjustment for various confounders. An interaction term was included to evaluate differential associations in pre- and postmenopausal women. Data on dual X-ray absorptiometry (DXA) measurements and serum UA levels were analyzed in a total of 206 patients. Among the 167 women 16 were premenopausal (age 40 ± 8 years) and 149 postmenopausal (age 65 ± 10 years). As expected, postmenopausal had lower T-scores than premenopausal patients (-1.53 ± 1.01 versus − 0.41 ± 1.29, respectively). No association of UA levels with T-scores was found when analyzing the whole cohort (Slope β: -0.04; p = 0.45). However, a significant negative correlation of UA with T-scores in premenopausal (Slope β: -0.98; p = 0.014), but not postmenopausal (Slope β: -0.04; p > 0.05) women was found. Uric acid appears to be negatively associated with bone mineral density in premenopausal but not in postmenopausal women with RA. Thus, the impact of UA on bone health seems to depend on the hormonal status of women. Further investigations are required to validate these results in a larger cohort of patients and to investigate the underlying mechanisms.
Zusammenfassung In Deutschland qualifiziert sich der Akut- und Notfallmediziner durch eine Facharztweiterbildung in Verbindung mit den Zusatz-Weiterbildungen „Klinische Akut- und Notfallmedizin“ und „Notfallmedizin“ gemäß den Vorgaben der Landesärztekammern, die sich auf die Empfehlungen der Bundesärztekammer beziehen. Eine zentrale Säule in der gebietsübergreifenden notfallmedizinischen Versorgung stellt das Gebiet der Inneren Medizin mit seinen Schwerpunkten dar. Das vorliegende Curriculum gibt einen umfassenden Überblick über internistische Weiterbildungsinhalte der Akut- und Notfallmedizin, die nach Ansicht der internistischen Gesellschaften (Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin [DGIIN], Deutsche Gesellschaft für Innere Medizin [DGIM] samt Schwerpunktgesellschaften, Berufsverband Deutscher Internistinnen und Internisten [BDI]) für den Erwerb der erforderlichen Kenntnisse und praktischen Fähigkeiten für eine bestmögliche Versorgung der akut- und notfallmedizinischen Patienten aus internistischer Sicht erforderlich scheinen. Das Curriculum stellt zum einen die allgemeinen Aspekte der klinischen Akut- und Notfallmedizin mit den Inhalten Struktur- und Prozessqualität, Erstdiagnostik, Initialtherapie und Indikationsstellung zur weiterführenden Behandlung, Schockraumversorgung, Diagnostik und Monitoring, generelle Therapieverfahren, Hygienemaßnahmen und Pharmakotherapie dar. Anschließend folgen spezifische Aspekte der Akut- und Notfallmedizin (angiologische, endokrinologische, diabetologische und metabolische, gastroenterologische, geriatrische, hämatoonkologische, infektiologische, kardiologische, nephrologische, palliativmedizinische, pneumologische, rheumatologische und toxikologische). Unterlegt sind die Themen jeweils mit auf das Weiterbildungskonzept zugeschnittenen Publikationen. Das Curriculum stellt für Internistinnen und Internisten alle internistischen Weiterbildungsinhalte der o. g. Zusatz-Weiterbildungen dar, zeigt aber auch allen Notfallmedizinern, mit welchen internistischen Krankheitsbildern sie bei ihrer Tätigkeit rechnen müssen.
