Ask an answerable question (PICO)：
Precocious puberty can limit children's growth potential, leading to reduced final adult height and exerting a profound and far-reaching impact on their life development. The standard treatment for central precocious puberty involves the administration of gonadotropin-releasing hormone analogs (GnRHa). However, the therapeutic benefits in terms of height gain and long-term safety risks of these medications are the primary clinical concerns for parents of children with precocious puberty. This article utilizes evidence-based strategy to inform parents about the benefits and risks of GnRHa treatment for precocious puberty, aiding in medical decision-making and improving the quality of life for affected children.
The Method and Analysis of Literature Review：
The question type is therapeutic type. Population= children with central precocious puberty; Intervention= treatment with gonadotropin-releasing hormone analogs; Comparison= no treatment with gonadotropin-releasing hormone analogs; Outcome= suppression of precocious puberty, height gain efficacy, side effects, long-term sequelae. Set keywords as central precocious puberty, GnRHa, triptorelin, leuprolide, effects, long term effects, complications, precocious puberty drug treatment, gonadotropin analogues. Use the MeSH function to search for synonymous words and Boolean logic "AND" and "OR" union and intersection strategies, and search databases such as PubMed, Cochrane Library, and CEPS. A total of 61 articles were obtained. After excluding non-relevant literature such as children with non-central precocious puberty, combined use of growth hormone, case reports, etc. Finally, one meta-analysis article exploring the effect of GnRHa on final height, and one systematic review and meta-analysis article exploring the long-term efficacy and safety of GnRHa. A total of 2 articles were included in the review.
Critical Appraisal：
The standard for evidence level evaluation is based on the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence. Use the Systematic review checklist of the Critical Appraisal Skills Program (CASP) (2018) for articles review. The article 1 is Level II, appraisal results: validity one item unclear and applicability one item unclear. The limitation of the study is: only one randomized controlled trial and the rest are not randomized controlled trials, the quality of the collected documents varies greatly, the overall quality is low, and the types and doses of GnRHa used varied significantly, and the duration of treatment was inconsistent. The article 2 is Level III, appraisal results: validity two items unclear and applicability one item unclear. The limitation of the study is: the heterogeneity of the included literature is high, the overall quality of the literature is low, and 98.5% of the research subjects are girls, the results cannot be inferred to boys.
Results, Conclusions and Recommendations：
The article 1, included 10 studies with a total of 720 cases, the meta-analysis results showed that compared with the control group, the GnRHa treatment group had significantly better final adult height (95% CI: 2.17~3.60, P<.001；I2=66.3%), height gain(95% CI: 2.17~3.60, P<.001；I2=66.3%), and the efficacy is better with a treatment duration of over 2 years (95% CI: 2.95~4.81, P<.001；I2=0%). The article 2, included 98 studies with a total of 5475 cases, the results indicate that GnRHa treatment can increase final adult height ≥2.32cm (95% CI: 2.32~7.34；I2=49%), reduce BMI (95% CI: -1.64~-0.37；I2=0%), and no significant difference in the incidence of polycystic ovary syndrome between those who received GnRHa treatment and those who did not (RR=1.21；95% CI: 0.46~3.15；I2=48%). Evidence results showed that GnRHa treatment benefits height gain in children with central precocious puberty, without conclusive evidence of impairing reproductive function or increasing long-term disease risk. GnRHa treatment for central precocious puberty has been practiced for many years. However, much of the research in this filed has focused on pubertal girls, leaving limited evidence regarding its effects on boys, lack of large-scale randomized controlled trials, and the variable quality of literature contribute to the inconsistency in evidence. This article suggest that clinical experts and practitioners continue to pay attention to this issue and invest in the development of high-quality comparative studies with sufficient sample size, long-term follow-up rate and duration, and including boys and girls.
張怡雯* 黃琼娛
