Efficacy and safety of aromatase inhibitors in the management of idiopathic short stature: A meta-analysis

Abstract

Objectives: Data are scant on the efficacy and safety of aromatase inhibitors (AIs) in idiopathic short stature (ISS). We undertook this meta-analysis to address this knowledge gap. Material and Methods: Electronic databases were searched for randomized control trials (RCTs) involving children with ISS receiving AIs compared to placebo/active comparator. The primary outcome was changes in predicted adult height (PAH). Secondary outcomes were alterations in bone age, puberty hormones, and side effects. Results: One-thousand three-hundred and eighty articles were reviewed, from which 4 RCTs which fulfilled all criteria were analyzed (one in the active control group [ACG] having growth hormone [GH] as an active comparator; three in the passive control group having placebo as controls). AIs were superior to placebo with regards to improvement in PAH (mean difference, MD 4.62 cm [95% confidence interval, CI: 4.02–5.23]; P < 0.01; I2 = 0%), bone-age progression (MD −0.61 years [95% CI: −0.87–−0.35]; P < 0.01; I2 = 0%) and height-standard deviation score improvement (MD 0.43 [95% CI: 0.33–0.53]; P < 0.01; I2 = 88%). No increased adverse events and spinal deformities were noted with AIs. Conclusion: AIs are safe and effective for improving height and pubertal outcomes in ISS. There remains scope for using AIs and GH together in ISS to have a synergistic impact on height outcomes.