Oral Propranolol Best for Reducing Infantile Hemangioma

Diana Swift

January 25, 2016

The beta-blocker propranolol, especially in oral form, more effectively reduces the size and volume of infantile hemangiomas than placebo, observation, and other treatments such as corticosteroids, according to a meta-analysis published online January 15 in Pediatrics.

Until recently, corticosteroids were the treatment of choice for infantile hemangiomas, despite having adverse effects and being only moderately effective for reducing these lesions, report Sivakumar Chinnadurai, MD, MPH, from the Department of Otolaryngology at Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues.

Their 18-study meta-analysis, based on cases included in Medline and other databases from 1982 to 2015, ranked treatments by mean expected rates of lesion clearance. The studies varied from randomized clinical trials to prospective and retrospective cohort studies and involved a total of 1265 patients with infantile hemangioma aged from 2 weeks to 9 years.

The studies variously conducted comparisons as follows: corticosteroid with corticosteroid, propranolol with placebo or observation, beta-blocker with beta-blocker, propranolol with corticosteroid, propranolol with another agent, timolol with placebo or observation, and timolol with another agent.

Interventions included intralesional propranolol, timolol, intralesional triamcinolone, and oral steroids, used across a range of hemangioma lesion types such as superficial, deep, and mixed. Most available evidence used in the meta-analysis, however, related to propranolol and corticosteroids, the authors note.

The largest mean estimate of expected clearance was for oral propranolol, at 95% (95% Bayesian credible interval [BCI], 88% - 99%). Next came timolol, at 62% (95% BCI, 39% - 83%), and intralesional triamcinolone, at 58% (95% BCI, 22% - 93%). Oral steroids had a moderate clearance rate of 43% (95% BCI, 21% - 66%), midway between beta-blockers and control (placebo or no treatment), for which the expected clearance rate was just 6% (95% BCI, 1% - 11%).

Only minimal data were available on intralesional propranolol.

Strength of evidence was high for propranolol's effects on reducing lesion size compared with observation/placebo. Strength of evidence was moderate for the effectiveness of corticosteroids for improving lesions. Strength of evidence was low for topical timolol vs placebo.

"Families and clinicians making treatment decisions should also factor in elements such as lesion size, location, number, and type, and patient and family preferences," write Dr Chinnadurai and colleagues.

They point to a critical need for research to determine which lesions are likely to respond best to specific agents. "Optimal treatment in the proliferative phase may be key to maximal resolution of [infantile hemangioma]," they write.

This study was supported by the Agency for Healthcare Research and Quality, US Department of Health and Human Services. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online January 15, 2016. Abstract

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