Comparative Efficacy of Gonadotropin-releasing Hormone Analogue (GnRHa) Monotherapy vs Combination Therapy for Central Precocious Puberty
Authors' conclusion
GH combination therapy enhances growth outcomes in children with CPP compared to GnRHa alone. Stanozolol, oxandrolone, and estrogen show promise but require further research. Personalized combination regimens and additional long-term RCTs are needed, particularly involving male patients and non-GH adjunctive therapies.
Study context
- Population
- Children aged ≤12 years with central precocious puberty (CPP) or early puberty, follow-up ≥6 months70 studies (30 randomized controlled trials (RCTs), 40 cohorts)
- Participants
- 5,266 children
- Comparison
- Growth hormone (GH) combination therapy vs GnRHa monotherapy
- Outcome
- Height gain (adult height minus pretreatment PAH), PAH change (posttreatment minus pretreatment PAH) and growth velocity (GV)
Methodological detailscommon- or random-effects models, Searched PubMed, EMBASE, Cochrane Library, Wanfang Data and CNKI through December 31, 2024
- Common- or random-effects models
- Searched PubMed, EMBASE, Cochrane Library, Wanfang Data and CNKI through December 31, 2024
Pooled result
As reported in the abstract
PAH change, GV and height gain
GH combination therapy vs GnRHa monotherapyMD, cm (95% CI)
PAH change, RCTs
3.48(2.98–3.98)
Height gain, cohort studies
3.81(2.77–4.84)
PAH change, cohort studies
3.06(2.26–3.86)
GH combination therapy vs GnRHa monotherapyMD, cm/y (95% CI)
GV, RCTs
1.82(1.32–2.31)
Further pooled results
Other adjuncts: stanozolol, oxandrolone, estrogen
- Stanozolol, oxandrolone and estrogen showed improved growth outcomes, although evidence was limited
Treatment duration and GH dose
- Longer treatment durations and higher GH doses were associated with greater benefits
Original publication
Comparative Efficacy of GnRHa Monotherapy vs Combination Therapy for Central Precocious Puberty. J Clin Endocrinol Metab. Published 12 November 2025. doi:10.
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