Beta-blockers for the treatment of problematic hemangiomas

Abstract

Objective To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas. Methods A retrospective review of patients with hemangiomas presenting to the Alberta Children's Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy. Results Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%). Conclusions Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.

Treatment of infantile hemangiomas: therapeutic options in regard to side effects and adverse events – a review of the literature

“…While the hydrophilic and more selective β-blocker atenolol is a promising alternative, its efficacy, side effects and adverse events spectrum have not been studied as extensively yet. [27][28][29][51][52][53] Topical β-blocker treatment possibly has less systemic adverse effects but it seems to be effective only in superficial IH. [31] ACE-inhibition seems to be a good alternative by its action mechanism, although literature is very limited and renal adverse effects at young age can be harmful.…”

Propranolol as a First-Line Treatment of Infantile Hemangioma: Single Center Experience

“…Recurrence was not observed after termination of treatment. The median duration of propranolol treatment was 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months. Photography of some selected cases are shown in figures 2 and 3.…”

“…Also, previous studies have reported rapidly partially regression and transformation of color in hemangiomas. 16,17,19 All patients who completed propranolol treatment have showed complete involution with minimal residue and also no recurrence at cessation of the therapy. By different studies in the literature involution rates of treatment ranging from 80 to 100% was given and they reported no recurrennce.…”

“…By different studies in the literature involution rates of treatment ranging from 80 to 100% was given and they reported no recurrennce. 16,17,19,24 Syrup form of propranolol is not available in Turkey. The propranolol solution was prepared by using 40 mg tablet form of drug, but dissolution of drug in water was difficult.…”

“…5,16,17,19 These reported side effects of propranolol treatment were cool extremities (26.7%), irritability (17.1%), lower Turkiye Klinikleri J Pediatr 2015;24 (2) gastrointestinal upset (14.3%), poor feeding (7.6%), lethargy (4.8%), rash (0.8%), emesis (12%), hypotension (10.5%), broncospasm (0.8%), bronchial hyperreactivity (21%), bradycardia (8%) in different studies. 16,17,19 Propranolol is a relatively safe drug that has been used during infancy and childhood for many years. In recent years experiences of hemangioma treatment with propranolol have been accumulated, consequently nowadays usage of propranolol is generally acknowledged for the first-line treatment of hemangioma by clinicians and parents.…”