Current perspectives on the optimal management of infantile hemangioma

Grzesik, Peter; Wu, June K.

doi:10.2147/phmt.s115528

Cited by 31 publications

(28 citation statements)

References 93 publications

(133 reference statements)

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“…Beta‐blockers are known to induce involution of infantile hemangiomas and are now considered first‐line treatment for problematic infantile hemangiomas. In 2014, the FDA‐approved formulation of propranolol solution for the treatment of infantile hemangiomas for infants aging 5 weeks to 5 months . After the successful use of oral propranolol in infantile hemangiomas, topical propranolol was tried for the management of superficial hemangiomas.…”

Section: β‐Blockers In Extra‐cardiac Conditionsmentioning

confidence: 99%

“…In 2014, the FDA-approved formulation of propranolol solution for the treatment of infantile hemangiomas for infants aging 5 weeks to 5 months. 70 After the successful use of oral propranolol in infantile hemangiomas, topical propranolol was tried for the management of superficial hemangiomas. A systematic review and meta-analysis of topical use of b-blockers for the treatment of hemangiomas observed that local application of bblockers can be an effective treatment option for superficial infantile hemangiomas and should be considered for primary treatment.…”

Section: Hemangiomasmentioning

confidence: 99%

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Trends in the off‐label use of β‐blockers in pediatric patients

Kaley

Aregullin

Samuel

et al. 2019

Pediatrics International

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The use of US Food and Drug Administration (FDA)‐approved drugs for the treatment of an unapproved indication or in an unapproved age group, or at doses or route of administration not indicated on the label is known as off‐label use. Off‐label use may be beneficial in circumstances when the standard‐of‐care treatment has failed, and/or no other FDA‐approved medications are available for a particular condition. In pediatric patients, off‐label use may increase the risk of adverse events as pharmacokinetic and pharmacodynamic data are limited in children. Approximately 73% of off‐label drugs currently prescribed for various conditions do not have sufficient scientific evidence for safety and efficacy. For example, β‐blockers are a class of drugs with FDA‐approval for very few indications in pediatrics but are commonly used for various off‐label indications. Interestingly, the proportion of off‐label use of β‐blockers in adults is at about 52% (66.2 million) of the total number of β‐blockers prescribed. The frequency of off‐label use of β‐blockers in children is also high with limited data on the indications as well as safety and efficacy. We present trends in off‐label use of β‐blockers in children to discuss drug safety and efficacy and include recommendations for pediatric providers.

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Section: β‐Blockers In Extra‐cardiac Conditionsmentioning

confidence: 99%

Section: Hemangiomasmentioning

confidence: 99%

Trends in the off‐label use of β‐blockers in pediatric patients

Kaley

Aregullin

Samuel

et al. 2019

Pediatrics International

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“…The treatment of splenic hemangioma in children has been mostly partial or total splenectomy [ 1 , 2 ], while Islam et al reported that the use of oral prednisolone that had an effective antiangiogenic effect in a large splenic hemangioma in an infant [ 3 ]. Recently, propranolol has been used for primary therapy of infantile hemangioma; however, to our knowledge, there have been no reports of propranolol for splenic hemangiomas [ 12 ]. Further studies may be needed to determine the effectiveness propranolol for splenic hemangioma.…”

Section: Discussionmentioning

confidence: 99%

Splenic embolization for a giant splenic hemangioma in a child: a case report

Choi

2018

BMC Pediatr

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BackgroundSplenic hemangioma is the most common benign tumor of the spleen. However, it remains a rare medical condition in children. Although the natural course of splenic hemangioma is slow growth, treatment for large splenic hemangiomas has been recommended due to the risk of spontaneous rupture causing life-threating hemorrhage. However, the optimal treatment for splenic hemangioma in children is unclear.Case presentationAn 11-year-old girl had an enhancing mass, 61 × 54 × 65 mm in size and numerous daughter nodules throughout the entire spleen on a contrast-enhanced computed tomography scan of the abdomen and angiography. The patient was treated by complete embolization at the distal level of splenic artery, which resulted in total splenic infarction. Treatment-related complications were thrombocytosis and postembolization syndrome, including abdominal pain and, intermittent fever below 39 °C. There were no other serious complications, including bleeding.ConclusionSplenic embolization may be a safe and less invasive intervention for children with a large splenic hemangioma. Further studies are needed to confirm the effectiveness of our approach.

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“…Infantile hemangioma (IH) is a common congenital vascular malformation that affects 4–5% of full-term infants ( Itinteang et al., 2014 ; Grzesik and Wu, 2017 ). The incidence of IH is higher in females than in males, with an estimated ratio of 3–5:1 ( Harter and Mancini, 2019 ; Wildgruber et al., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Combined Topical Timolol and Oral Propranolol for Treating Infantile Hemangioma: A Meta-Analysis of Randomized Controlled Trials

et al. 2020

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Background Oral propranolol has become the first-line treatment for infantile hemangioma (IH). However, combined therapy with topical timolol and oral propranolol has been proposed as a more effective IH treatment strategy. We aimed to compare the safety and efficacy of topical timolol, oral propranolol, and their combination for treating IH in a meta-analysis. Methods Relevant randomized controlled trials (RCTs) were obtained after searching the PubMed, Embase, Cochrane’s Library, China National Knowledge Infrastructure, and WanFang databases. A random-effect model was used to pool the results. Results Eight RCTs with 759 patients with IH were included in this meta-analysis. Treatment with topical timolol alone showed a similar response rate compared to oral propranolol (risk ratio [RR] = 0.97, p = 0.63), but resulted in fewer adverse events (RR = 0.36, p = 0.002). Combined treatment with topical timolol and oral propranolol showed a favorable response rate compared to treatment with oral propranolol (RR = 1.14, p = 0.03) or topical timolol (RR = 1.36, p = 0.01) alone. Moreover, combined treatment showed similar risks of adverse events compared to oral propranolol (RR = 0.80, p = 0.24) or topical timolol (RR = 1.31, p = 0.25) alone. Conclusions Combined treatment with topical timolol and oral propranolol may be more effective than either single treatment strategy in patients with IH. Topical timolol alone conferred similar efficacy for IH compared to oral propranolol, but with less incidence of adverse events.

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Current perspectives on the optimal management of infantile hemangioma

Cited by 31 publications

References 93 publications

Trends in the off‐label use of β‐blockers in pediatric patients

Trends in the off‐label use of β‐blockers in pediatric patients

Splenic embolization for a giant splenic hemangioma in a child: a case report

Efficacy of Combined Topical Timolol and Oral Propranolol for Treating Infantile Hemangioma: A Meta-Analysis of Randomized Controlled Trials

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