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Evaluating the Efficacy of Pharmacological Therapy for Prader-Willi Syndrome: A Systematic Review and Meta-analysis

  • Alim, Yoo (Department of Clinical Medicinal Sciences, Konyang University) ;
  • Sohyeon, Park (Department of Clinical Medicinal Sciences, Konyang University) ;
  • Heeyoung, Lee (Department of Clinical Medicinal Sciences, Konyang University)
  • Received : 2022.10.01
  • Accepted : 2022.12.21
  • Published : 2022.12.31

Abstract

Background: Prader-Willi Syndrome (PWS) is a rare genetic disorder. To improve the health deterioration of PWS, investigating optimal treatment options for PWS is required. Thus, we aimed to evaluate the efficacy of pharmacotherapies compared with supportive care or placebos in patients with PWS. Methods: PubMed and EMBASE databases were used to search for randomized controlled trials (RCTs) evaluating the efficacy of pharmacotherapy in PWS patients. Only RCTs that evaluating the efficacy of pharmacotherapy in PWS patients were retrieved. Results: A total of 26 studies were included to evaluate body composition, hormones, glucose levels and hyperphagia behavioral status. Pharmacological treatment group showed a significant decrease of body fat (mean difference (MD): -6.32, 95% confidence interval (CI): -10.58 to -2.06, p=0.004), a significant increase of lean body mass (LBM) (MD: 1.86, 95% CI: 1.43 to 2.30, p<0.00001) and insulin-like growth factor 1 (IGF-1) levels (MD: 241.62, 95% CI: 68.59 to 414.64, p=0.006) compared with the control group. Nevertheless, based on other outcomes evaluated by the current systematic review, pharmacological options showed different efficacy in treating PWS. Conclusion: Pharmacological therapies were effective to decrease significantly in body fat and increase significantly on LBM and IGF-1 levels in patients with PWS. However, still, individualized therapies should be considered in real-world practice in PWS treatment.

Keywords

References

  1. Luo Y, Zheng Z, Yang Y, et al. Effects of growth hormone on cognitive, motor, and behavioral development in Prader-Willi syndrome children: a meta-analysis of randomized controlled trials. Endocrine 2021;71(2):321-30. https://doi.org/10.1007/s12020-020-02547-3
  2. McCandless SE, Suh M, Yin D, et al. Sun-604 U.S. Prevalence & mortality of Prader-Willi syndrome: a population-based study of medical claims. J Endocr Soc 2020;4(Supplement_1):SUN-604.
  3. Butler MG, Bittel DC, Kibiryeva N, Talebizadeh Z, Thompson T. Behavioral differences among subjects with Prader-Willi syndrome and type 1 or type 2 deletion and maternal disomy. Pediatrics 2004;113(3 Pt 1):565-73. https://doi.org/10.1542/peds.113.3.565
  4. Yang L, Zhan GD, Ding JJ, et al. Psychiatric illness and intellectual disability in the Prader-Willi syndrome with different molecular defects--a meta analysis. PLoS One 2013;8(8):e72640. https://doi.org/10.1371/journal.pone.0072640
  5. Butler MG, Miller JL, Forster JL. Prader-Willi syndrome - clinical genetics, diagnosis and treatment approaches: an update. Curr Pediatr Rev 2019;15(4):207-44. https://doi.org/10.2174/1573396315666190716120925
  6. Clements AC, Dai X, Walsh JM, et al. Outcomes of adenotonsillectomy for obstructive sleep apnea in Prader-Willi syndrome: systematic review and meta-analysis. Laryngoscope 2021;(4)131:898-906.
  7. Kim SJ. Obesity and metabolic syndrome in adults with Prader-Willi syndrome. J Mucopolysacch Rare Dis 2015;1(2):44-8. https://doi.org/10.19125/JMRD.2015.1.2.44
  8. Tan Q, Orsso CE, Deehan EC, et al. Current and emerging therapies for managing hyperphagia and obesity in Prader-Willi syndrome: a narrative review. Obes Rev 2020;21(5):e12992. https://doi.org/10.1111/obr.12992
  9. Schmidt H, Pozza SB, Bonfig W, Schwarz HP, Dokoupil K. Successful early dietary intervention avoids obesity in patients with Prader-Willi syndrome: a ten-year follow-up. J Pediatr Endocrinol Metab 2008;21(7):651-5.
  10. Felix G, Kossoff E, Barron B, Krekel C, Testa EG, Scheimann A. The modified atkins diet in children with Prader-Willi syndrome. Orphanet J Rare Dis 2020;15(1):135. https://doi.org/10.1186/s13023-020-01412-w
  11. Miller JL, Tan M. Dietary management for adolescents with Prader-Willi syndrome. Adolesc Health Med Ther 2020;11:113-8.
  12. Passone CGB, Franco RR, Ito SS, et al. Growth hormone treatment in Prader-Willi syndrome patients: systematic review and meta-analysis. BMJ Paediatr Open 2020;4(1):e000630. https://doi.org/10.1136/bmjpo-2019-000630
  13. Ng NBH, Low YW, Rajgor DD, et al. The effects of glucagon-like peptide (GLP)-1 receptor agonists on weight and glycaemic control in Prader-Willi syndrome: a systematic review. Clin Endocrinol (Oxf) 2022;96(2):144-54. https://doi.org/10.1111/cen.14583
  14. Rosenberg AGW, Passone CGB, Pellikaan K, et al. Growth hormone treatment for adults with Prader-Willi syndrome: a meta-analysis. J Clin Endocrinol Metab 2021;106(10):3068-91. https://doi.org/10.1210/clinem/dgab406
  15. Sanchez-Ortiga R, Klibanski A, Tritos NA. Effects of recombinant human growth hormone therapy in adults with Prader-Willi syndrome: a meta-analysis. Clin Endocrinol (Oxf) 2012;77(1):86-93. https://doi.org/10.1111/j.1365-2265.2011.04303.x
  16. Page MJ, Higgins JP, Sterne JA. Chapter 13: Assessing risk of bias due to missing Results in a Synthesis. Available from https://training.cochrane.org/handbook/current/chapter-13. Accessed September 18, 2022.
  17. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64(4):401-6 https://doi.org/10.1016/j.jclinepi.2010.07.015
  18. Carrel AL, Myers SE, Whitman BY, Allen DB. Growth hormone improves body composition, fat utilization, physical strength and agility, and growth in Prader-Willi syndrome: a controlled study. J Pediatr 1999;134(2):215-21. https://doi.org/10.1016/S0022-3476(99)70418-X
  19. Damen L, Grootjen LN, Juriaans AF, et al. Oxytocin in young children with Prader-Willi syndrome: results of a randomized, double-blind, placebo-controlled, crossover trial investigating 3 months of oxytocin. Clin Endocrinol (Oxf) 2021;94(5):774-85. https://doi.org/10.1111/cen.14387
  20. Consoli A, Cabal Berthoumieu S, Raffin M, et al. Effect of topiramate on eating behaviours in Prader-Willi syndrome: TOPRADER double-blind randomised placebo-controlled study. Transl Psychiatry 2019;9(1):274. https://doi.org/10.1038/s41398-019-0597-0
  21. McCandless SE, Yanovski JA, Miller J, et al. Effects of MetAP2 inhibition on hyperphagia and body weight in Prader-Willi syndrome: a randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2017;19(12):1751-61. https://doi.org/10.1111/dom.13021
  22. Allas S, Caixas A, Poitou C, et al. Azp-531, an unacylated ghrelin analog, improves food-related behavior in patients with Prader-Willi syndrome: a randomized placebo-controlled trial. PLoS One 2018;13(1):e0190849. https://doi.org/10.1371/journal.pone.0190849
  23. Sze L, Purtell L, Jenkins A, et al. Effects of a single dose of exenatide on appetite, gut hormones, and glucose homeostasis in adults with Prader-Willi syndrome. J Clin Endocrinol Metab 2011;96(8):E1314-9. https://doi.org/10.1210/jc.2011-0038
  24. Motaghedi R, Lipman EG, Hogg JE, Christos PJ, Vogiatzi MG, Angulo MA. Psychiatric adverse effects of rimonobant in adults with prader willi syndrome. Eur J Med Genet 2011;54(1):14-8. https://doi.org/10.1016/j.ejmg.2010.09.015
  25. De Waele K, Ishkanian SL, Bogarin R, et al. Long-acting octreotide treatment causes a sustained decrease in ghrelin concentrations but does not affect weight, behaviour and appetite in subjects with Prader-Willi syndrome. Eur J Endocrinol 2008;159(4):381-8. https://doi.org/10.1530/EJE-08-0462
  26. Selikowitz M, Sunman J, Pendergast A, Wright S. Fenfluramine in Prader-Willi syndrome: a double blind, placebo controlled trial. Arch Dis Child 1990;65(1):112-4. https://doi.org/10.1136/adc.65.1.112
  27. Einfeld SL, Smith E, McGregor IS, et al. A double-blind randomized controlled trial of oxytocin nasal spray in prader willi syndrome. Am J Med Genet A 2014;164A(9):2232-9.
  28. Kuppens RJ, Donze SH, Hokken-Koelega AC. Promising effects of oxytocin on social and food-related behaviour in young children with Prader-Willi syndrome: a randomized, double-blind, controlled crossover trial. Clin Endocrinol (Oxf) 2016;85(6):979-87. https://doi.org/10.1111/cen.13169
  29. Hoybye C, Bruun JM, Richelsen B, Flyvbjerg A, Frystyk J. Serum adiponectin levels in adults with Prader-Willi syndrome are independent of anthropometrical parameters and do not change with gh treatment. Eur J Endocrinol 2004;151(4):457-61. https://doi.org/10.1530/eje.0.1510457
  30. Myers SE, Carrel AL, Whitman BY, Allen DB. Sustained benefit after 2 years of growth hormone on body composition, fat utilization, physical strength and agility, and growth in Prader-Willi syndrome. J Pediatr 2000;137(1):42-9. https://doi.org/10.1067/mpd.2000.105369
  31. Hoybye C, Frystyk J, Thoren M. The growth hormone-insulin-like growth factor axis in adult patients with Prader Willi syndrome. Growth Horm IGF Res 2003;13(5):269-74. https://doi.org/10.1016/S1096-6374(03)00017-0
  32. Haqq AM, Stadler DD, Jackson RH, Rosenfeld RG, Purnell JQ, LaFranchi SH. Effects of growth hormone on pulmonary function, sleep quality, behavior, cognition, growth velocity, body composition, and resting energy expenditure in Prader-Willi syndrome. J Clin Endocrinol Metab 2003;88(5):2206-12. https://doi.org/10.1210/jc.2002-021536
  33. Festen DA, de Lind van Wijngaarden R, van Eekelen M, et al. Randomized controlled GH trial: effects on anthropometry, body composition and body proportions in a large group of children with Prader-Willi syndrome. Clin Endocrinol (Oxf) 2008;69(3):443-51. https://doi.org/10.1111/j.1365-2265.2008.03228.x
  34. Hauffa BP. One-year results of growth hormone treatment of short stature in Prader-Willi syndrome. Acta Paediatr Suppl 1997;423:63-5. https://doi.org/10.1111/j.1651-2227.1997.tb18373.x
  35. Bakker NE, Siemensma EP, Koopman C, Hokken-Koelega AC. Dietary energy intake, body composition and resting energy expenditure in prepubertal children with Prader-Willi syndrome before and during growth hormone treatment: a randomized controlled trial. Horm Res Paediatr 2015;83(5):321-31. https://doi.org/10.1159/000374113
  36. Lindgren AC, Hagenas L, Ritzen EM. Growth hormone treatment of children with Prader-Willi syndrome: effects on glucose and insulin homeostasis. Horm Res 1999;51(4):157-61. https://doi.org/10.1159/000023350
  37. Lindgren AC, Hagenas L, Muller J, et al. Growth hormone treatment of children with Prader-Willi syndrome affects linear growth and body composition favourably. Acta Paediatr 1998;87(1):28-31. https://doi.org/10.1080/08035259850157822
  38. Carrel AL, Moerchen V, Myers SE, Bekx MT, Whitman BY, Allen DB. Growth hormone improves mobility and body composition in infants and toddlers with Prader-Willi syndrome. J Pediatr 2004;145(6):744-9. https://doi.org/10.1016/j.jpeds.2004.08.002
  39. Hoybye C, Hilding A, Jacobsson H, Thoren M. Growth hormone treatment improves body composition in adults with Prader-Willi syndrome. Clin Endocrinol (Oxf) 2003;58(5):653-61. https://doi.org/10.1046/j.1365-2265.2003.01769.x
  40. Kuppens RJ, Bakker NE, Siemensma EP, et al. Beneficial effects of GH in young adults with Prader-Willi syndrome: a 2-year crossover trial. J Clin Endocrinol Metab 2016;101(11):4110-16. https://doi.org/10.1210/jc.2016-2594
  41. Festen DA, van Toorenenbergen A, Duivenvoorden HJ, Hokken-Koelega AC. Adiponectin levels in prepubertal children with Prader-Willi syndrome before and during growth hormone therapy. J Clin Endocrinol Metab 2007;92(4):1549-54. https://doi.org/10.1210/jc.2006-2241
  42. Sode-Carlsen R, Farholt S, Rabben KF, et al. One year of growth hormone treatment in adults with Prader-Willi syndrome improves body composition: results from a randomized, placebo-controlled study. J Clin Endocrinol Metab 2010;95(11):4943-50. https://doi.org/10.1210/jc.2010-0907
  43. de Lind van Wijngaarden RF, Cianflone K, Gao Y, Leunissen RW, Hokken-Koelega AC. Cardiovascular and metabolic risk profile and acylation-stimulating protein levels in children with Prader-Willi syndrome and effects of growth hormone treatment. J Clin Endocrinol Metab 2010;95(4):1758-66. https://doi.org/10.1210/jc.2009-0656
  44. Burman P, Ritzen EM, Lindgren AC. Endocrine dysfunction in Prader-Willi syndrome: a review with special reference to GH. Endocr Rev 2001;22(6):787-99. https://doi.org/10.1210/er.22.6.787
  45. Cadilhac DA, Cumming TB, Sheppard L, Pearce DC, Carter R, Magnus A. The economic benefits of reducing physical inactivity: an Australian example. Int J Behav Nutr Phys Act 2011;8:99. https://doi.org/10.1186/1479-5868-8-99
  46. Scheimann AO, Lee PDK, Ellis KJ. Gastrointestinal System, obesity, and body composition. In: Butler MG, Lee PDK, Whitman BY, eds. Management of Prader-Willi Syndrome, New York: Springer, 2006: 153-200.
  47. Butler MG, Manzardo AM, Heinemann J, Loker C, Loker J. Causes of death in Prader-Willi syndrome: Prader-Willi syndrome association (USA) 40-year mortality survey. Genet Med 2017;19(6):635-42. https://doi.org/10.1038/gim.2016.178
  48. Carrek AL, Lee PDK, Mogul HR. Growth hormone and Prader-Willi syndrome. In: Butler MG, Lee PDK, Whitman BY, eds. Management of Prader-Willi Syndrome, New York: Springer, 2006: 201-241
  49. Butler MG, Moore J, Morawiecki A, Nicolson M. Comparison of leptin protein levels in Prader-Willi syndrome and control individuals. Am J Med Genet 1998;75(1):7-12. https://doi.org/10.1002/(SICI)1096-8628(19980106)75:1<7::AID-AJMG3>3.0.CO;2-T
  50. Centers for Disease Control and Prevention. Body mass index : considerations for practitioners. Available from https://stacks.cdc.gov/view/cdc/25368. Accessed September 18, 2022.
  51. Poskitt EM. Defining childhood obesity: the relative body mass index (BMI). Acta Paediatr 1995;84(8):961-3. https://doi.org/10.1111/j.1651-2227.1995.tb13806.x
  52. Nuttall FQ. Body mass index: obesity, bmi, and health: a critical review. Nutr Today 2015;50(3):117-28. https://doi.org/10.1097/NT.0000000000000092
  53. Aycan Z, Bas VN. Prader-Willi syndrome and growth hormone deficiency. J Clin Res Pediatr Endocrinol 2014;6(2):62-7. https://doi.org/10.4274/Jcrpe.1228
  54. Paterson WF, Donaldson MD. Growth hormone therapy in the Prader-Willi syndrome. Arch Dis Child 2003;88(4):283-5. https://doi.org/10.1136/adc.88.4.283
  55. Bakker NE, Kuppens RJ, Siemensma EP, et al. Eight years of growth hormone treatment in children with Prader-Willi syndrome: maintaining the positive effects. J Clin Endocrinol Metab 2013;98(10):4013-22. https://doi.org/10.1210/jc.2013-2012
  56. Eiholzer U, Stutz K, Weinmann C, Torresani T, Molinari L, Prader A. Low insulin, igf-1 and igfbp-3 levels in children with Prader-Labhart-Willi syndrome. Eur J Pediatr 1998;157(11):890-3. https://doi.org/10.1007/s004310050961
  57. Muscogiuri G, Barrea L, Faggiano F, et al. Obesity in Prader-Willi syndrome: physiopathological mechanisms, nutritional and pharmacological approaches. J Endocrinol Invest 2021;44(10): 2057-70. https://doi.org/10.1007/s40618-021-01574-9
  58. Nagai T, Mori M. Prader-Willi syndrome, diabetes mellitus and hypogonadism. Biomed Pharmacother 1999;53(10):452-4. https://doi.org/10.1016/S0753-3322(00)88102-0
  59. Qian Y, Xia F, Zuo Y, et al. Do patients with Prader-Willi syndrome have favorable glucose metabolism? Orphanet J Rare Dis 2022;17(1):187. https://doi.org/10.1186/s13023-022-02344-3
  60. Woldaregay AZ, Launonen IK, Arsand E, Albers D, Holubova A, Hartvigsen G. Toward detecting infection incidence in people with type 1 diabetes using self-recorded data (part 1): a novel framework for a personalized digital infectious disease detection system. J Med Internet Res 2020;22(8):e18911. https://doi.org/10.2196/18911
  61. Elena G, Bruna C, Benedetta M, Stefania DC, Giuseppe C. Prader-Willi syndrome: clinical aspects. J Obes 2012;2012:473941. https://doi.org/10.1155/2012/473941
  62. Jin DK. Systematic review of the clinical and genetic aspects of Prader-Willi syndrome. Korean J Pediatr 2011;54(2):55-63. https://doi.org/10.3345/kjp.2011.54.2.55
  63. McCormack SE, Blevins JE, Lawson EA. Metabolic effects of oxytocin. Endocr Rev 2020;41(2):121-45. https://doi.org/10.1210/endrev/bnz012
  64. Moller N, Jorgensen JO, Moller J, et al. Metabolic effects of growth hormone in humans. Metabolism 1995;44(10 Suppl 4):33-6.
  65. Crino A, Grugni G. Update on diabetes mellitus and glucose metabolism alterations in Prader-Willi syndrome. Curr Diab Rep 2020;20(2):7. https://doi.org/10.1007/s11892-020-1284-5
  66. Goodarzi MO, Cui J, Chen YD, Hsueh WA, Guo X, Rotter JI. Fasting insulin reflects heterogeneous physiological processes: role of insulin clearance. Am J Physiol Endocrinol Metab 2011; 301(2):E402-8. https://doi.org/10.1152/ajpendo.00013.2011
  67. Achari AE, Jain SK. Adiponectin, a therapeutic target for obesity, diabetes, and endothelial dysfunction. Int J Mol Sci 2017;18(6):1321 https://doi.org/10.3390/ijms18061321
  68. Ouchi N, Walsh K. Adiponectin as an anti-inflammatory factor. Clin Chim Acta 2007;380(1-2):24-30. https://doi.org/10.1016/j.cca.2007.01.026