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Inclusion Criteria:

* Main cohort: Aged ≥2 years to \<11 years (up to the day before 11th birthday inclusive) at time of enrollment; or exploratory cohort: aged ≥3 months to \<2 years (up to the day before 2nd birthday inclusive) at time of enrollment
* Documented, confirmed genetic diagnosis of achondroplasia from historical medical records prior to entry into this trial (test must have been performed at a laboratory fully accredited for genetic testing under local regulations).
* Completed the C4181001 natural history study with at least 2 valid height/length measurements (at least 3 months apart) prior to enrollment in this study. One of these measurement timepoints must be within the 3 months prior to enrollment in C4181005.
* Tanner stage 1 based on investigator assessment during physical examination (must include assessment of breast development for females, testicular stage for males).
* Able to stand independently for height measurements (if ≥2 years of age at enrollment).
* If aged \<2 years at enrollment, has a documented historical MRI brain/cervical spine performed in the previous 12 months.

Exclusion Criteria:

* Presence of co-morbid conditions or circumstances that, in the opinion of the investigator, would affect interpretation of growth data or ability to complete the trial procedures.
* Other medical or psychiatric condition including recent (within the past year) or active suicidal ideation/behavior or laboratory abnormality that may increase the risk of study participation or, in the investigator's judgment, make the participant inappropriate for the study.
* Presence of severe obesity (BMI \>95th percentile on Hoover-Fong BMI charts) \[Hoover-Fong et al, 2008\].14
* Known closure of long bone growth plates (cessation of height growth).
* Body weight \<7 kg or \>30 kg.
* Moderate or severe renal impairment CrCL GFR \<60 mL/min/1.73m2 (Calculated GFR based on updated "bedside" Schwartz formula for pediatric patients (CrCL (mL/min/1.73 m2) = 0.413 \* Height (cms)/ Serum cr (mg/dL) or hepatic impairment (AST/ALT \>1.5 ULN).
* History of hypersensitivity to study intervention or any excipients.
* History of any prior treatment with human growth hormone or related products (including insulin-like growth factor 1 \[IGF-1\]).
* History of receipt of any treatment that are known to potentially affect growth (including oral steroids \>5 days in the last 6 months, high dose inhaled corticosteroids (\>800 mcg/day beclametasone equivalent) and medication for attention deficit hyperactivity disorder).
* History of limb lengthening surgery (defined as distraction osteogenesis/Ilizarov/callostasis technique following submetaphyseal osteotomy to extend bone length).
* Any limb lengthening/corrective orthopaedic surgery planned at any point during the trial period.
* Less than 6 months since fracture or surgical procedure of any bone determined from the screening visit date.
* Presence of any internal guided growth plates/devices.
* History of removal of internal guided growth plates/devices within less than 6 months.
* History of receipt of any investigational product for achondroplasia or that may affect growth/interpretation of growth parameters.
* History of receipt of an investigational product (not for achondroplasia/growth affecting) within the last 30 days or 5 half-lives (whichever is longer).

• Aliso Viejo, California, United States
• Irvine, California, United States
• Long Beach, California, United States
• Torrance, California, United States
• Wilmington, Delaware, United States
• Houston, Texas, United States
• Melbourne, Victoria, Australia
• Parkville, Victoria, Australia
• Edegem, Belgium
• Leuven, Belgium
• Copenhagen NV, Denmark
• Roma, Italy
• Suita, Osaka, Japan
• Okayama, Japan
• Coimbra, Portugal
• Vitoria-Gasteiz, Alava, Spain