What are the therapeutic uses and precautions for peptides, such as growth hormone-releasing peptides (GHRPs), in medical treatment?

Therapeutic Uses and Precautions for Peptides in Medical Treatment

Growth hormone-releasing peptides (GHRPs) and other therapeutic peptides should only be used for approved medical indications under strict clinical supervision due to potential serious adverse effects and limited evidence supporting their use outside established guidelines.

Approved Therapeutic Uses of Peptides

Growth Hormone (GH) Therapy

• GH therapy is recommended for children with chronic kidney disease (CKD) who have persistent growth failure 1
• GH should be administered at 0.045-0.05 mg/kg body weight per day via subcutaneous injections in the evening 1
• Both reference and biosimilar GH products are recommended for approved indications 1, 2
• GH therapy requires regular monitoring (every 3-6 months) of:
  • Height velocity, pubertal development, skeletal maturation 1, 2
  • Thyroid function, glucose levels, calcium, phosphate, and PTH levels 1

Growth Hormone-Releasing Peptides (GHRPs)

• GHRPs stimulate endogenous GH secretion through specific receptors at both pituitary and hypothalamic levels 3, 4
• Limited approved clinical applications exist for GHRPs compared to recombinant GH therapy 3
• Some GHRPs have shown potential for treating certain GH hyposecretory states in clinical research settings 3

Contraindications and Safety Concerns

Absolute Contraindications

• Active malignancy or history of malignancy 2
• Intracranial hypertension (requires immediate discontinuation if it occurs) 1
• Closed epiphyses (for growth-promoting effects) 1
• Severe secondary hyperparathyroidism (PTH >500 pg/ml) 1
• Critical acute illness 2

Precautions and Monitoring Requirements

• Regular monitoring of glucose metabolism is essential as GH/GHRPs can increase insulin resistance 1
• Careful assessment of bone health is required as peptides may unmask or worsen secondary hyperparathyroidism 1
• GH therapy should be discontinued with:
  • Slipped capital femoral epiphysis 1, 2
  • Accelerated bone maturation 1
  • Unexplained decrease in renal function 1
  • Inadequate response despite optimal metabolic control 1

Special Populations Considerations

Children and Adolescents

• Growth hormone therapy requires careful monitoring of growth velocity and bone maturation 1
• Treatment should be discontinued at epiphyseal closure 1, 2
• In CKD patients, GH should be stopped at the time of renal transplantation 1

Adults

• For adults with glucocorticoid-induced osteoporosis at very high fracture risk, parathyroid hormone/parathyroid hormone-related protein (PTH/PTHrP) peptides are conditionally recommended over anti-resorptive agents 1
• In acromegaly management, somatostatin receptor ligands (peptides) are recommended as first-line medical therapy 1

Emerging Applications and Research

• Peptides are increasingly recognized for their high selectivity, efficacy, and relatively good safety profiles in targeted applications 5
• Approximately 140 peptide therapeutics were in clinical trials as of 2015, indicating growing interest in this therapeutic class 5
• Peptide biomarkers are emerging as diagnostic tools for various diseases including neurodegenerative disorders, heart failure, infectious diseases, and cancer 6

Important Precautions Regarding Unapproved Use

• GHRPs are prohibited substances on the World Anti-Doping Agency (WADA) list 7
• Unauthorized use of GHRPs carries significant health risks without proven clinical benefits 7, 4
• The metabolism and excretion of GHRPs vary significantly between different peptides, affecting detection windows and potential adverse effects 7

Monitoring for Efficacy and Adverse Effects

• If height velocity in the first year of GH treatment is less than 2 cm per year over baseline, evaluate:
  • Patient adherence to therapy 1
  • Appropriate weight-adjusted dosing 1
  • Nutritional and metabolic factors 1
• Monitor for potential adverse effects including:
  • Glucose intolerance 1
  • Secondary hyperparathyroidism 1
  • Orthopedic complications 1, 2
  • Fluid retention 2