Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review and<scp>GRADE</scp>assessments

Novoa, Mónica; Baselga, Eulàlia; Beltrán, Sandra; Giraldo, Lucía; Shahbaz, Ali; Pardo-Hernández, Héctor; Arévalo-Rodríguez, Ingrid

doi:10.1111/bjd.17407

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…The rapid growth of IH lesions is usually discovered during 5-8 weeks and about 80% of their growth are completed by the age of 3 months. It is widely accepted that the β-adrenergic receptor plays a crucial role in regulating the growth of IH [20][21][22]. Propranolol, as a nonselective β-blocker, could elicit inhibitory effects through inducing vasoconstriction, angiogenesis inhibition and apoptosis induction [23].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials

et al. 2020

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Background: To evaluate the efficacy and safety of topical β-blockers in the treatment of superficial infantile hemangiomas (SIH) and mixed infantile hemangiomas (MIH), respectively, and compare the efficacy and safety of topical β-blockers with other interventions. Methods: The PRISMA guidelines were adhered to. We searched for randomized controlled trials in databases from 2010 to 2018 comparing topical β-blockers with other interventions for infantile hemangiomas. The outcomes evaluated were efficacy and adverse effects. Data analyses were performed using RevMan 5.3. Publication bias was assessed to account for bias in patient selection. Results: Eleven studies, involving 1,235 patients, were subjected to this meta-analysis. Six studies compared topical β-blockers with other interventions (propranolol, placebo, corticosteroids or pulsed dye laser) in treating SIH, and 5 studies evaluated the efficacy and safety of a topical β-blocker when it was combined with another intervention in treating MIH. A topical β-blocker was discovered to be as effective as oral propranolol in treating SIH (risk ratio, RR, 0.96, 95% confidence interval, CI, 0.91–1.02, p = 0.20, I2 = 0%), and topical β-blockers were more beneficial than placebo, corticosteroids or pulsed dye laser in treating SIH (RR 2.25, 95% CI 1.66–3.05, p < 0.00001, I2 = 0%). Topical β-blockers combined with another intervention gave rise to a better clinical response in the treatment of MIH than intervention alone (RR 1.99, 95% CI 1.10–3.60, p = 0.02, I2 = 55%) (standard mean difference 0.80, 95% CI 0.28–1.31, p = 0.002, I2 = 0%). Compared with oral propranolol, topical β-blockers were associated with fewer incidences of adverse effects (RR 0.05, 95% CI 0.01–0.39, p = 0.004, I2 = 0%). No significant difference in adverse effects was found when a topical β-blocker was combined with another intervention in treating MIH (RR 1.01, 95% CI 0.58–1.74, p = 0.98, I2 = 0%). Conclusions: This meta-analysis provided evidence that topical β-blockers may replace oral propranolol as first-line therapy for SIH and that they are of additive value in treating MIH.

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Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials

et al. 2020

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“…Although adverse effects are transient and mild, apart from symptomatic hypotension and bradycardia [10], discontinuation of treatment may be required in certain instances [11]. Oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other resolution measures, or both, without an increase in harm [12].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Combined Steroid-propranolol Therapy on the Involution of Infantile Hemangioma

Soliman¹,

Mowafy²,

Maksoud³

et al. 2020

AJP

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Infantile hemangioma (IH) is the most common benign vascular neoplasm of infancy, occurring in 1.0-2.5% of white infants, especially girls. Steroids and propranolol are the most widely used drugs as a primary treatment for IH. Although their mechanism of action is not well understood, their beneficial effect is documented. Our purpose was to compare the clinical efficacy of propranolol alone and propranolol combined with steroids on the outcome of IH. A total of 450 children (median age: 9 months; range: 7 days to 3 years) were included in this randomized controlled study, being treated with combined steroid and propranolol (Group A: 230 children) compared to those treated with propranolol plus placebo (Group B: 220 children). The steroid was given as a loading dose of 2-3 mg/kg/day and then gradually tapered over 6 months, whereas propranolol was given as an incremental dose starting at 0.16 mg/kg/day and reaching a maximum of 2 mg/kg/day maintained for 18 months (duration of therapy). Frequent monitoring of the blood sugar level was mandatory in the first 2 months: electro-and echocardiograms were recorded initially but not repeated. A more rapid involution rate, recognized by color fading and flattening of the lesions, was noted in Group A compared to Group B, with the peak response reached after 10 months of therapy followed by a slower but steady rate of further improvement. No major adverse effects were observed in Group A with regard to hypoglycemia or hypotension. On the other hand, ten cases of vomiting and diarrhea, one case of fungal infection and twelve cases of somnolence and fatigue were observed in Group B. Steroid induction seems to cover the gap at initiation of therapy where propranolol cannot be given as a full dose, especially in neonates. Steroid combination minimizes the adverse effects of propranolol, namely, hypoglycemia, hypotension and bradycardia. Children treated with a combined regimen showed more effective clearing of lesions, were less likely to require surgery for residual lesions and had minimal adverse effects compared to the single-drug group. In both groups there was a faster clearing rate for the head and neck lesions than elsewhere in the body, which can be explained by the higher blood flow to this region, magnifying the level of medication to these lesions and achieving a better response.

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“…A visual analog scale is used for detecting the color and size of the lesions. They recommend 2 mg/kg/day nal dose for infantile hemangioma(13).Propranolol is safe in infantil hemangioma treatmentç Propranolol's e cacy is well established comparing with plasebo in infantil hemangioma. There are few studies comparing the dose of 2 mg/kg/day versus 3 mg/kg/day propranolol's e cacy and side effects in infantil hemangioma.…”

mentioning

confidence: 99%

Infantil Hemangioma and Optimum Dose of Propranolol Treatment: A Retrospective Tertiary-Center Study

Cakmak

Kartal

2021

Preprint

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Background/Objectives: Propranolol is the mainstay treatment of infantile hemangioma, and the optimal dose is unclear. Few studies are comparing the efficacy of propranolol dose of 2 vs.3 mg/kg/day. We compared the efficacy between these two doses and propranolol groups with no treatment group. Methods: One hundred eight patients with infantile hemangioma (15 days-27 months of age) were examined. The patients with high-risk features and/or a score of >6 points are given propranolol with a final dose of 2 or 3 mg/kg/day according to tolerance for 6-12 months. The resolutions rates for propranolol vs. placebo and propranolol 2 mg/kg/day vs. 3 mg/kg/day are compared. Results: The demographic and clinical features of the groups ( the non-treatment, propranolol 2 mg/kg/day group, propranolol 3 mg/kg/day group) are similar. Propranolol is significantly efficent in infantil hemangioma treatment (p<0.001). The resolution rates are not statistically different between 2 mg/kg/day propranolol group vs 3 mg/kg/day propranolol group at the sixth (68,59 ± 28,95 vs 73,44 ± 32,54)(p=0,673) and twelfth month (p=0,673) (89,08 ± 46,58 vs 91,13 ± 37,46 respectively )of follow up. A milld (n=3)(4%) adverse event was reported with no need for cessation.Conclusions: Propranolol is a safe drug for treating infantile hemangioma with an ideal dose of 2 mg/kg/day rather than 3 mg/kg/day.

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Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review andGRADEassessments

Abstract: This summary relates to https://doi.

Cited by 9 publications

References 33 publications

The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials

The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials

The Impact of Combined Steroid-propranolol Therapy on the Involution of Infantile Hemangioma

Infantil Hemangioma and Optimum Dose of Propranolol Treatment: A Retrospective Tertiary-Center Study

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