In the final segment, Joshua Yang, MD, synthesizes his views on the clinical role of long-acting growth hormone analogs, arguing that these agents should be understood as a meaningful advancement for selected patients rather than merely a convenience upgrade over daily therapy.

Long-Acting Growth Hormone Analogs: Beyond Convenience to Individualized Care

He reiterates that treatment burden is not a trivial consideration in a chronic, injectable therapy often initiated in childhood and continued for many years. For families struggling with daily injections, weekly long-acting formulations can substantially reduce logistical challenges and psychological fatigue associated with treatment.

Yang places particular emphasis on adherence as a key mediator between dosing schedule and long-term outcomes. Drawing parallels with other therapeutic areas in which extended-interval regimens have improved adherence, he suggests that if long-acting GH analogs consistently enhance treatment persistence, clinicians should expect to see corresponding gains in auxologic outcomes over time.

However, he cautions that these expectations must be confirmed through robust real-world data, including ongoing and future registries that capture long-term growth trajectories and safety findings in diverse patient populations. The promise of better adherence must be matched by careful monitoring and evidence generation.

Looking ahead, Yang envisions a shift toward more sophisticated individualization of GH therapy that extends beyond simple weight-based dosing. He anticipates that clinicians will increasingly tailor treatment based on dynamic parameters such as IGF-1 profiles, adherence patterns, and potentially other biomarkers or digital health data captured in real-world practice. In his view, real-world observations and registry analyses will be essential in defining optimal dosing strategies that maximize efficacy while minimizing risk.

By leveraging these data, clinicians can refine the use of long-acting GH analogs to deliver more precise, patient-centered care for children with GHD and related growth disorders.

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An expert explains why long-acting growth hormone analogs represent more than a convenience upgrade, emphasizing adherence, treatment burden, and future directions in individualized dosing.


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In this segment, Joshua Yang, MD, offers a practical perspective on how clinicians should incorporate registry data into decision-making for patients receiving growth hormone therapy, including long-acting formulations. He emphasizes that registries should be viewed as a complement, rather than a replacement, for randomized clinical trials.

Leveraging Growth Hormone Registries to Inform Long-Term Treatment Decisions

Randomized trials remain the gold standard for demonstrating efficacy under controlled conditions, but their relatively short duration and selective inclusion criteria limit the ability to fully characterize rare safety events, long-term outcomes, and treatment patterns in heterogeneous populations.

Yang highlights treatment persistence as a central domain where registries provide critical insights beyond those available from trials. In randomized studies, adherence is typically high and closely monitored, whereas registry data reflect the realities of day-to-day use in the community. With long-acting GH analogs, registries can help determine whether reduced injection frequency translates into improved persistence and, ultimately, better growth outcomes such as height velocity and near-adult height.

Additionally, he notes that registries allow clinicians to answer questions that families frequently pose, such as what to expect at 5, 10, or 15 years of therapy and how outcomes compare among patients with similar diagnoses or baseline characteristics.

Looking ahead, Yang anticipates that growth hormone registries will become even more informative as they integrate electronic health records, adherence metrics, and patient-reported outcomes. This evolution will expand their role from primarily safety surveillance to a more comprehensive characterization of real-world effectiveness, quality of life, and care patterns.

By synthesizing data from randomized trials and registries, clinicians will be better equipped to counsel families about long-term expectations, balance benefits and risks, and individualize therapy across the spectrum of GHD and related indications. Yang suggests that this trajectory mirrors the historical experience with daily GH and will be essential for building similar confidence in long-acting analogs over the coming decades.

An expert discusses how clinicians can apply registry data alongside randomized trial evidence to address long-term safety, persistence, and real-world outcomes in growth hormone therapy.


In this portion of the discussion, Joshua Yang, MD, contrasts the roles of randomized clinical trials and real-world registries in assessing growth hormone therapies, with a particular focus on long-acting GH analogs. He frames clinical trials as essential for determining whether a therapy can work under controlled conditions, whereas registries are critical for understanding how that therapy performs in routine clinical practice.

Real-World Registries vs Clinical Trials in Long-Acting Growth Hormone Therapy

Historically, large registries such as KIGS (Pfizer International Growth Database) and NCGS (National Cooperative Growth Study) accumulated decades of data on daily GH therapy, providing robust evidence for long-term efficacy and safety that underpinned clinical confidence in daily GH use.

Yang notes that long-acting GH analogs represent a different class of molecules, even though they are related to daily GH, and therefore warrant their own extensive real-world evaluation. He explains that emerging long-acting GH registries are beginning to generate meaningful longitudinal data, mirroring the process that occurred with daily GH several decades ago.

These registries capture diverse patient populations, extended follow-up periods, and broader clinical scenarios than those represented in registration trials. Over time, these data will help confirm whether the long-term efficacy and safety of long-acting GH analogs align with or differ from those of traditional daily formulations.

Importantly, Yang underscores that registries are particularly valuable for evaluating populations and clinical questions not fully addressed in clinical trials. He highlights, for example, patients with a prior history of malignancy, who are often excluded from randomized trials but appear in real-world datasets. In addition, he points to expanded indications for long-acting GH—such as small for gestational age (SGA), idiopathic short stature, and Noonan syndrome—as areas where registry data can help define expected outcomes across varied clinical settings and geographies.

By capturing real-world patterns of use, efficacy, and safety across diagnoses and regions, registries offer clinicians a more comprehensive evidence base to guide counseling and long-term management decisions for patients treated with long-acting GH analogs.


An expert compares insights from historical and contemporary growth hormone registries with randomized trial data, highlighting their complementary roles in evaluating long-acting GH analogs.


Stevan Gonzalez, MD, MS, is the Director of Liver Transplantation at Baylor Scott and White All Saints Medical Center in Fort Worth, Texas. 

Chronic Liver Disease: How PCPs Can Improve Early Detection

Since chronic liver disease often presents with "silent" symptoms, improving early detection requires support beyond hepatologists; primary care clinicians and community-based health organizations can develop their role in increasing awareness and expanding screening efforts.

“We're recognizing that chronic liver disease in the US is vastly underestimated, and it's beyond what a liver specialist can do in terms of the general population,” Steven Gonzalez, MD, MS, Director of Liver Transplantation at Baylor Scott & White Health, said in an interview with 

his talk from the 2026 Liver Health Symposium, hosted by the Global Liver Institute. “That's where our primary care providers and our community-based health organizations are going to play a very important role in increasing awareness, education, and screening.”

How Much of the US is Impacted by Chronic Liver Disease?

According to the Centers for Disease Control and Prevention (CDC), chronic liver disease is the 9th leading cause of death in the United States. In total, 1.8% of adults ≥ 18 years of age have been diagnosed with liver disease, standing at 4.5 million individuals. Furthermore, an estimated 33% of US adults have metabolic dysfunction-associated steatotic liver disease (MASLD), while cirrhosis impacts around 2.6% of the population.

Why Don’t More Patients Know They Have Liver Disease?

As Gonzalez explains, the liver is a “resilient” organ.

As such, one of the greatest challenges is that chronic liver disease often progresses without noticeable symptoms. Since the liver can continue functioning despite ongoing injury, patients may live with inflammation and fibrosis for years or even decades before receiving a diagnosis.

By the time cirrhosis develops, the liver has often sustained irreversible scarring. At that stage, patients may begin experiencing fatigue, nausea, unintentional weight loss, or mild cognitive impairment.

The American Liver Foundation emphasizes that early intervention, whether through alcohol cessation, treatment of viral hepatitis, or management of obesity and metabolic disease, can halt disease progression and, in some patients, reverse early-stage liver damage before irreversible scarring develops.

One reason many cases go undetected is that routine laboratory testing does not specifically screen for liver fibrosis. Liver enzyme testing, fibrosis assessments, and imaging are often performed only after clinicians suspect underlying liver disease or identify patients at increased risk

What Characteristics Should Clinicians Look Out For in Chronic Liver Disease?

In recent years, rates of chronic liver disease, particularly alcohol-associated liver disease (ALD) and MASLD, have increased.

“There are groups of populations in the U.S. who are disproportionately affected by alcohol-associated liver disease, and that includes women, younger people, and Native Americans.”

Gonzalez said addressing the growing burden of chronic liver disease will require a broader public health approach, with primary care clinicians, community organizations, and hepatologists working together to identify at-risk patients before irreversible liver damage occurs. Earlier screening, patient education, and timely referral, he noted, may represent the greatest opportunity to reduce the long-term impact of chronic liver disease.

Editor’s Note: Gonzalez reports relevant disclosures with Mallinckrodt Pharmaceuticals, Salix, AbbVie, Gilead, and others. 

Centers for Disease Control and Prevention. FastStats. CDC. Published October 11, 2019. Accessed July 10, 2026. 

https://www.cdc.gov/nchs/fastats/liver-disease.htm

Hazeldine S, Hydes T, Sheron N. Alcoholic liver disease – the extent of the problem and what you can do about it. Clinical Medicine. 2015;15(2):179-185. doi:10.7861/clinmedicine.15-2-179

Paik JM, Shah D, Eberly K, Golabi P, Henry L, Younossi ZM. Changes in mortality due to Chronic Liver Diseases (CLD) during the COVID-19 pandemic: Data from the United States” National Vital Statistics System. PloS one. 2024;19(9):e0289202. doi:10.1371/journal.pone.0289202

Earlier diagnosis is imperative for chronic liver disease; Stevan Gonzalez, MD, MS, explains how PCPs and community-based screening programs can help. 

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MASH / MASLD

The HCPLive MASH & MASLD page is a comprehensive resource for clinical news and insights on metabolic dysfunction-associated steatotic liver disease and steatohepatitis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for fatty liver disease, steatohepatitis, and more.

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Chronic Liver Disease: How PCPs Can Improve Early Detection 

An expert reviews key considerations for IGF-1 monitoring, timing of blood draws, and dose individualization when transitioning patients from daily growth hormone to long-acting analogs.

IGF-1 Monitoring and Dose Optimization With Long-Acting Growth Hormone Analogs

In the second segment, Joshua Yang, MD, focuses on dose optimization and monitoring strategies for patients receiving long-acting growth hormone (GH) analogs, with particular attention to the interpretation of IGF-1 levels. He explains that clinicians transitioning from daily to long-acting GH must adapt their monitoring practices because the pharmacokinetics of weekly formulations differ substantially from those of daily injections. Whereas daily GH therapy generally produces relatively flat IGF-1 profiles over 24 hours, long-acting analogs are characterized by a weekly peak and trough pattern, making the timing of blood draws critical for accurate assessment.

Yang stresses that each long-acting GH analog has distinct pharmacokinetic properties, molecular structure, and dosing parameters, and that these products are not interchangeable. As a result, clinicians must be familiar with product-specific recommendations regarding when to obtain IGF-1 measurements—whether at or near peak, trough, or at a timepoint that best approximates average weekly exposure.

He notes that, for the long-acting products currently in use, consensus and practical experience often support measuring IGF-1 around day 4 after the injection to approximate mean exposure over the dosing interval. When patients cannot access the laboratory on the ideal day, validated calculators can assist in estimating average IGF-1 exposure from off-schedule draws.

Despite the emphasis on precise timing, Yang reiterates that IGF-1 is one component of a broader clinical assessment rather than a sole determinant of management decisions. In his approach, IGF-1 data are interpreted alongside growth velocity, duration of treatment, pubertal status, and indicators of adherence. For example, suboptimal height velocity in the context of appropriate IGF-1 levels may prompt a reassessment of adherence, comorbidities, or pubertal progression rather than immediate dose escalation.

By integrating pharmacokinetic understanding with individualized clinical judgment, Yang suggests that clinicians can safely optimize long-acting GH dosing while maintaining a focus on both efficacy and long-term safety.

Jenny Murase, MD, is a board-certified dermatologist and Associate Clinical Professor at UCSF who practices at the Palo Alto Medical Foundation in Mountain View, California. She is also a globally recognized expert specializing in women’s health in dermatology.

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During her SDPA Conference interview, Murase gave several more tips for skin management during pregnancy.

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How to Safely Treat Acne, Psoriasis, and Eczema During Pregnancy

Adam Tanious, MD, MBA, is an associate professor within the Division of Vascular Surgery at the Medical University of South Carolina.

Richard Shi, MD, and Adam Tanious, MD, MBA, discuss the suboptimal number of patients at risk of long-term complications due to nonadherence.

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Increasing Guideline-Directed Care Adherence in Peripheral Artery Disease

Chelsie Derman is an associate editor for 

who covers allergy and  psychiatry. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Arthur Caplan, PhD, and Dominic Sisti, PhD, revisit Jahi McMath's 5 years on a ventilator and what her case still says about how death is diagnosed.

Medical Ethics Unpacked

Medical Ethics Unpacked is a regular multimedia series hosted by Dominic Sisti, PhD, and Steve Levine, MD, spotlighting a spectrum of topics within the field of medical ethics. Throughout the year, hosts will sit down for an in-depth discussion on a specific ethical dilemma within modern healthcare, with some episodes also featuring a special guest. 

Check back throughout the year for discussions on a variety of topics, including data privacy in health apps, euthanasia and medical assistance in dying, reproductive rights and technologies, and more!

How Jahi McMath's Case Exposed the Limits of Brain Death

In this SDPA interview, Murase provides tips for clinicians on conversations related to pregnancy, safety, and skin disease management.

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Tips for Safe Management of Skin Disease During Pregnancy, With Jenny Murase, MD

George Martin, MD, a dermatologist at the Dermatology and Laser Center of Maui and the co-founder of Scholars in Medicine and Maui Dermatology.

Topical ruxolitinib shows sustained repigmentation over years, while oral JAK inhibitors move toward approval for widespread disease, George Martin, MD, says.

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Pigmentation Pipeline: Vitiligo and Melasma Treatment Advances

Allan B. Massie, PhD, is an associate professor in the Department of Surgery and an associate professor in the Department of Population Health at NYU Langone.

Nearly half of kidney transplant candidates never start evaluation with access barriers varying by patient background.



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The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Chronic Kidney Disease

Why Fewer Than Half of Referred Patients Reach Kidney Transplant Evaluation

In this episode, Dominic Sisti and Steve Levine talk with Arthur Caplan, PhD, about how the concept of brain death was built and why it still generates controversy 50 years later.

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Medical Ethics Unpacked: The History and Ethics of Brain Death

Raj Vuppalanchi, MD, is a Professor of Medicine, Director of Hepatology, and Associate Program Director at the Indiana University School of Medicine.

Raj Vuppalanchi, MD, shares insights on saroglitazar, EPICS-III, and the future of personalized treatment for PBC.

Saroglitazar and the Evolving PBC Treatment Landscape, With Raj Vuppalanchi, MD

Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

Oklahoma APPs share real-world asthma and COPD biologic wins, safety surprises, and insurance hurdles as new twice-yearly options emerge.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

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Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Biologic Therapy for Asthma and COPD: Real-World Perspectives From APPs

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Eplontersen did not significantly reduce cardiovascular mortality and recurrent cardiovascular events in the phase 3 CARDIO-TTRansform trial.

Latest News

Long-Acting Growth Hormone Analogs: Beyond Convenience to Individualized Care

Leveraging Growth Hormone Registries to Inform Long-Term Treatment Decisions

Real-World Registries vs Clinical Trials in Long-Acting Growth Hormone Therapy

Chronic Liver Disease: How PCPs Can Improve Early Detection

IGF-1 Monitoring and Dose Optimization With Long-Acting Growth Hormone Analogs