Beta-blockers for prevention and treatment of retinopathy of prematurity in preterm infants

Kaempfen, Sirée; Neumann, Roland; Jost, Kerstin; Schulzke, Sven

doi:10.1002/14651858.cd011893

Cited by 6 publications

(11 citation statements)

References 46 publications

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“…The main advantage of using propranolol to treat ROP is that it can be used orally and does not require intraocular injections of anti-VEGF such as bevacizumab (Avastin). Also, it avoids the use of sedation or anesthetic agents causing hemodynamic instability Our updated systematic review employed a very recent literature review, even including an unpublished RCT [18], and our results provide data based on the largest number of included infants in the beta-blocker group compared with previously published meta-analysis [16].…”

Section: Discussionmentioning

confidence: 99%

“…However, other animal studies reported neither oral, subcutaneous, or intraperitoneal propranolol successfully prevent development of ROP [14], while others caution against potential systemic antiadrenergic side effects [15]. Beta blockers, due to their anti-VEGF properties, have been employed as primary and secondary preventing agent for ROP in both animal models, and preterm infants, but there was not enough evidence to support or refute its use for ROP in premature infants at the time of a recent Cochrane review [16]. The Cochrane review included only few studies related with the use of propranolol.…”

Section: Introductionmentioning

confidence: 99%

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Oral propranolol in prevention of severe retinopathy of prematurity: a systematic review and meta-analysis

et al. 2019

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Objective To systematically assess the efficacy of oral beta blockage treatment in primary (before established) and secondary (in threshold stages) prevention of severe retinopathy of prematurity (ROP) in premature infants born ≤32 weeks gestational age. Study design Following the PRISMA guidelines, published literature was systematically assessed up to April 27, 2018. Trials and observational studies, in which beta blockage was used to prevent severe ROP (defined as stage ≥3, or requiring treatment) were included. Meta-analyses including random effects models were conducted to determine the overall effect of oral beta blockage on prevention of ROP. Results Six studies (five clinical trials and one observational study) including 461 infants met inclusion criteria using propranolol. The pooled relative risk (RR) of severe ROP in the primary and secondary prophylaxis groups were 0.65 (95% CI 0.43-0.98, NNT = 7) and 0.48 (95% CI 0.35-0.65, NNT = 6) in RCTs, respectively. The RR of severe ROP in one observational study was 0.21 (95% CI 0.08-0.55) with a NNT of 3. There were low heterogeneity and publication bias. Side effects occurred in 8.4% of participants on propranolol. Conclusions Systematic assessment of studies showed that prophylactic oral propranolol appeared to be effective in preventing severe ROP in premature infants ≤32 weeks gestational age. Additional well powered, multinational, randomized control trials reporting on long-term outcomes are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral propranolol in prevention of severe retinopathy of prematurity: a systematic review and meta-analysis

et al. 2019

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“…We found 62 systematic reviews (SR) with the strategy search, seven fulfilled the inclusion criterias (8)(9)(10)(11)(12)(13)(14) and were included in this overview. Four SR (8,10,11,12) approach to prophylaxis for ROP and four SR (8,9,13,14) approach the treatment for ROP as summarized in table 2 and a brief narrative synthesis of each SR is presented below. The quality of evidence of the outcomes assessed by GRADE (15) whenever it is presented by the review author both in table as in narrative synthesis.…”

Section: Search Resultsmentioning

confidence: 99%

“…Beta-blockers (8) Different experimental models showed a decrease in β-adrenergic function that can result in a reduction or exacerbation of vascular changes. Thus beta-blockers can act to inhibit vascular proliferation in retinal vascular diseases.…”

Section: Prevention Of Retinopathy Of Prematuritymentioning

confidence: 99%

Analysis of Cochrane Systematic Reviews about retinopathy of prematurity

Mozetic¹,

Cruz²,

Cruz³

et al. 2021

Revista Brasileira De Oftalmologia

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Background: Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects extremely premature infants and is the leading cause of irreversible blindness in childhood. Objective: This study presents a review of Cochrane systematic reviews about ROP. Methods: We analyzed and summarized the results of all intervention, prevention and treatment, from Cochrane Systematic Reviews (SR) for ROP designed to the highest standard of rigor to show the current position and propose studies that are missing for decision making. Results: Eight SR were analyzed in this study, four in prophylaxis and four in treatment of ROP. The outcome 'Beneficial effect of oral beta-blockers on progression to stage 3 ROP but not to stage 2 ROP with plus disease or to stage 4 or 5 ROP was the only one that presented moderate evidence quality, all the others outcomes presented evidence quality floating from low to very low. Conclusion: There is a lack of studies showing the quality of evidence in the treatment and prevention of retinopathy of prematurity, particularly in long-term outcomes after treatment in order to assess the impact and quality of life of these patients.

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“…Although there has been effective treatments for severe ROP, they are either invasive such as laser treatment or expensive such as anti-VEGF agents [10]. Besides, several studies indicated propranolol might be a potential effective drug for ROP [11–13]. However, the quality of the studies was not high and the safety of propranolol remained to be proved.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of inositol supplementation in preterm infants to prevent retinopathy of prematurity: a systematic review and meta-analysis

Wang

et al. 2019

BMC Ophthalmol

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Background Inositol supplementation has been linked to beneficial effects on reducing the incidence of retinopathy of prematurity (ROP); however, it’s controversial. The meta-analysis aimed to check out the efficacy and safety of inositol supplementation in preterm infants for preventing ROP. Methods We conducted searches through PubMed, EMBASE, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ClinicalTrials.gov website and conference proceedings. Randomized controlled trials comparing inositol supplementation with placebo were included. Two independent reviewers performed screening, review, and extraction. Statistical analysis was performed using R Project. Results Six studies (1194 infants) were proved eligible. In comparison with placebo, inositol supplementation revealed no effect on the incidence of severe ROP (relative risk [RR] = 0.49, 95% confidence interval [CI], 0.18–1.32; heterogeneity, P = .02; I 2 = 66%; low quality of evidence [QOE]), mortality (RR = 1.25, 95% CI, 0.82–1.90; heterogeneity, P = .07; I 2 = 51%; low QOE), all stages of ROP (RR = 0.98, 95% CI, 0.87–1.11; heterogeneity, P = .41; I 2 = 0%; moderate QOE) and other adverse events. Sensitivity analysis showed an increased mortality in the inositol group (RR = 1.55, 95% CI, 1.14–2.11; heterogeneity, P = .30; I 2 = 18%) after removing the study Hallman 1986, and meta-regression showed a significant association between publication year and efficacy of inositol compared with placebo (β = 0.1241; 95% CI, 0.0417–0.0026; z = 2.9527; p = .0032). Conclusions Based on current evidence, inositol supplementation showed no significant effect on preventing severe ROP, and exploratory sensitivity analysis showed a trend toward an increase on mortality. Electronic supplementary material The online version of this article (10.1186/s12886-019-1140-z) contains supplementary material, which is available to authorized users.

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Beta-blockers for prevention and treatment of retinopathy of prematurity in preterm infants

Cited by 6 publications

References 46 publications

Oral propranolol in prevention of severe retinopathy of prematurity: a systematic review and meta-analysis

Oral propranolol in prevention of severe retinopathy of prematurity: a systematic review and meta-analysis

Analysis of Cochrane Systematic Reviews about retinopathy of prematurity

The efficacy and safety of inositol supplementation in preterm infants to prevent retinopathy of prematurity: a systematic review and meta-analysis

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