Atenolol vs. propranolol for the treatment of infantile haemangiomas: A systematic review and meta‑analysis

Liu, Zhuang; Wu, Changhua; Song, Dan; Wang, Liang; Li, Jing; Wang, Changfeng; Guo, Lei

doi:10.3892/etm.2020.8842

Cited by 14 publications

(28 citation statements)

References 27 publications

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“…11,77) No significant difference in efficacy was reported between the lipophilic non-selective beta-blocker propranolol and the hydrophilic selective beta-1 blocker atenolol. 9,11,78) Topical timolol maleate Topical timolol maleate, a non-selective -adrenergic receptor antagonist, has been used as a first-line agent for several decades in the treatment of pediatric glaucoma and since 2010 in the treatment of IHs. 9,16,52,[79][80][81][82][83][84][85] The 2019 AAP CPG on IH management states that timolol maleate 0.5% gel-forming ophthalmic solution may be topically applied to small, thin, and superficial IHs at a dose of 1-2 drops applied twice daily for 6-9 months until 12 months of age or occasionally longer depending on IH size.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

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Update on infantile hemangioma

Jung

2021

Clin Exp Pediatr

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The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5-10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age.High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a non-selective betaadrenergic antagonist, is the first-line treatment for IHs at a dosage of 2-3 mg/kg/day divided into two daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical non-selective beta-blocker, may be used for small superficial type IHs at a dosage of 1-2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.

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Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

“…Propranolol is superior to oral captopril at treating problematic IHs and to ibuprofen and paracetamol at treating ulcerated IHs [ 11 , 77 ]. No significant difference in efficacy was reported between the lipophilic nonselective beta-blocker propranolol and the hydrophilic selective beta-1 blocker atenolol [ 9 , 11 , 78 ].…”

Section: Treatment Of Ihmentioning

confidence: 99%

Update on infantile hemangioma

Jung

2021

Clin Exp Pediatr

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“…Patient treated with propranolol has more adverse reaction and higher relapse rate. Results suggests that atenolol is not inferior to propranolol and may offer advantage with lower adverse reaction and relapse rate [6].a retrospective review of medical records was done on paediatric patient with haemangioma with propranolol. 88 patients with infantile haemangioma was treated with propranolol.…”

Section: Discussionmentioning

confidence: 99%

A Rare and Challenging Patient of Infantile Haemangioma: Case Report

Varma

Naqvi

et al. 2021

JPRI

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Infantile haemangioma is a condition seen in premature babies, it develops as a birth mark that grows in size commonly seen on back, chest, scalp, the swelling is characterised by bleeding or oozing. In such patients primary concern is any ill effects due to medical condition and secondary concern is cosmetic. A 9 month old baby brought to the hospital with complaints of swelling on the back with oozing. The patient was given IV propranolol for 1 year. And wound care was taught along with ergonomic education for ADLS. The study suggests that the use of IV propranolol shows significant reduction in the swelling and oozing from the swelling.

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“… 61 – 65 A systematic review and meta-analysis comparing atenolol 0.5–1 mg/kg/day to propranolol 2 mg/kg/day showed that atenolol was non-inferior to propranolol in treating IHs and possibly has a lower risk of adverse reactions. 62 In theory, atenolol’s specificity for the beta-1 receptor and its hydrophilic property preventing the penetration of the blood–brain barrier are thought to have advantages over propranolol in terms of safety. 62 , 66 In a retrospective study, metoprolol was compared to propranolol at 2 mg/kg/day dose and showed comparable effectiveness with a potentially better safety profile.…”

Section: Reviewmentioning

confidence: 99%

“… 62 In theory, atenolol’s specificity for the beta-1 receptor and its hydrophilic property preventing the penetration of the blood–brain barrier are thought to have advantages over propranolol in terms of safety. 62 , 66 In a retrospective study, metoprolol was compared to propranolol at 2 mg/kg/day dose and showed comparable effectiveness with a potentially better safety profile. 63 Acebutolol at 8–10 mg/kg/day has successfully been used to treat IHs without complications in two case series.…”

Section: Reviewmentioning

confidence: 99%

Paediatrics: how to manage infantile haemangioma

Kim¹,

Lam²

2021

DIC

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Infantile haemangiomas (IHs) are relatively common benign vascular tumours found in the paediatric population. They have varying sizes and involve different depths in the skin leading to various colours, shapes and textures. Although considered harmless in most cases, they may lead to life-threatening complications or cause permanent disfigurations and organ dysfunction. For problematic IHs, the treatment options include oral and topical beta-blockers, systemic corticosteroids, laser treatment, and surgery. In this narrative review, the treatment options for problematic IH are compared and delivered concisely to facilitate the clinical decisions from practitioners, including those in primary care settings. Oral propranolol is currently considered the first-line intervention for problematic IHs. For superficial lesions, there is robust evidence for the use of topical timolol maleate. Systemic corticosteroids are sometimes used in specific situations such as resistance or contraindications to beta-blockers. Surgical excision can be considered in cases requiring urgent intervention such as airway obstruction; this can be done alongside laser therapies for the removal of residual tissue or when reconstructing areas of deformity. The combination of multiple treatment modalities may lead to a more rapid clinical response.

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Atenolol vs. propranolol for the treatment of infantile haemangiomas: A systematic review and meta‑analysis

Cited by 14 publications

References 27 publications

Update on infantile hemangioma

Update on infantile hemangioma

A Rare and Challenging Patient of Infantile Haemangioma: Case Report

Paediatrics: how to manage infantile haemangioma

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