Oral Propranolol: A New Treatment for Infants with Retinopathy of Prematurity?

Bührer, Christoph; Bassler, Dirk

doi:10.1159/000381659

Cited by 19 publications

(11 citation statements)

References 23 publications

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“…Studies have shown that polymorphisms of the β-adrenergic receptor in many black infants may be responsible for the lower incidence of ROP (107). Clinical trials have shown reduction in the incidence of ROP with oral propranolol with few side effects (108)(109)(110). Clinical trials in Israel and Italy are being conducted to evaluate efficacy and safety of this beta blocker for ROP prevention in preterm neonates.…”

Section: Propranololmentioning

confidence: 99%

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

Aranda

Valencia

et al. 2019

Seminars in Perinatology

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Retinopathy of prematurity (ROP), a significant morbidity in prematurely born infants, is the most common cause of visual impairment and blindness in children and persists till adulthood. Strict control of oxygen therapy and prevention of intermittent hypoxia are key in the prevention of ROP, but pharmacologic interventions have decreased risk of ROP. Various drug classes such as methylxanthines (caffeine), VEGF inhibitors, anti-oxidants, and others have decreased ROP occurrence. The timing of pharmacologic intervention remains unsettled, but early prevention rather than controlling disease progression may be preferred. These drugs act through different mechanisms and synergistic approaches should be considered to maximize efficacy and safety.

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Section: Propranololmentioning

confidence: 99%

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

Aranda

Valencia

et al. 2019

Seminars in Perinatology

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“…Oral propranolol (0.25 or 0.5 mg/kg/6 h) was given in a pilot trial to preterm infants with stage 2 ROP during phase II ROP [54] and the authors concluded that the drug was effective in decreasing the progression of ROP but that safety was a concern. Recently, there have been two small randomized controlled trials of oral propranolol as a treatment for stage 2 or more (zone 2) ROP or stage 1 (zone 1) ROP [55]. These trials had unclear methodology, but 6 infants with ROP interventions from 35 propranolol-treated infants compared to 14 out of 36 control infants (p = 0.055, relative risk 0.44, 95% CI: 0.19-1.02) translates to a number needed to treat of 5.…”

Section: New Therapeutic Options For Ropmentioning

confidence: 99%

“…These trials had unclear methodology, but 6 infants with ROP interventions from 35 propranolol-treated infants compared to 14 out of 36 control infants (p = 0.055, relative risk 0.44, 95% CI: 0.19-1.02) translates to a number needed to treat of 5. Oral propranolol is a promising treatment to prevent progression to threshold ROP, but systematic studies are needed before it can be recommended [55]. A trial of propranolol during phase I to prevent ROP in infants with gestation of 26-32 weeks starting at 1 week of age and continuing until 37 weeks or complete vascularization of retina is ongoing (CTRI/2013/11/004131).…”

Section: New Therapeutic Options For Ropmentioning

confidence: 99%

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

Cayabyab¹,

Ramanathan²

2016

Neonatology

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Retinopathy of prematurity (ROP) continues to be a major preventable cause of blindness and visual handicaps globally. With improved perinatal care, improved survival of moderately preterm infants, and limited resources for oxygen delivery and monitoring, more mature preterm infants are developing severe ROP in developing countries. The pathophysiology of ROP is characterized by two phases. Phase I ROP is due to vaso-obliteration beginning immediately after birth secondary to a marked decrease in vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1). Phase II begins around 33 weeks' postmenstrual age (PMA). During this phase, VEGF levels increase, especially if there is retinal hypoxia with increasing retinal metabolism and demand for oxygen leading to abnormal vasoproliferation. Since the original description of ROP in 1942 by Terry et al. [Am J Ophthalmol 1942;25:203-204], four epidemics of ROP have been observed. Prevention or early treatment of ROP involves careful titration of oxygen saturation by pulse oximeter (SpO₂). Optimal SpO₂ target remains elusive. Most of the large trials have focused on either a low SpO₂ (85-89%) or a high SpO₂ (91-95%) from the first day of birth to 36 weeks' PMA. Although the incidence of severe ROP and bronchopulmonary dysplasia decreased significantly, predischarge mortality was higher in these studies. Use of graded SpO₂ during the 2 different phases of ROP (early, low SpO₂ during phase I vs. late, high SpO₂ during phase II) may be the best approach to prevent this disabling condition. Further trials should focus on this strategy. Other biological agents that are currently being studied include IGF-1 with IGF-binding protein-3 (rhIGF-1 + rhIGFBP-3) and propranolol. For advanced stages of ROP, laser ablation of avascular retina, early treatment of ROP (ETROP) protocol, intravitreal injection of anti-VEGF antibodies (e.g. bevacizumab) and vitrectomy are used to protect central vision and prevent retinal detachment. Long-term complications such as refractory errors, recurrence of ROP and risk of retinal detachment require continued follow-up with an ophthalmologist through adolescence and beyond. Optimal nutrition including adequate intake of omega-3 polyunsaturated fatty acids and decreasing infection/inflammation to promote normal vascularization are important strategies. Screening guidelines for ROP based on local incidence of ROP in different regions of the world are very important. Oxygen therapy is clearly a modifiable risk factor to decrease ROP that needs further study. Understanding the two phases of ROP will help to identify appropriate therapeutic strategies and improve visual outcomes in many preterm infants globally.

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“…These studies demonstrated a lesser progression to stage 3 or stage 3 plus. Combining the published data of the trials by Filippi et al 7 and Makhoul et al 15 would result in 6 infants needing ROP interventions out of 35 propranolol-treated infants, as opposed to 14 out of 36 control infants (p=0.055, RR 0.44, 95% CI 0.19 to 1.02, relative density (RD) 0.22, number needed to treat (NNT)=5) 18. Though the study of Bancalari et al 16 showed a decrease in the need for intervention with laser or bevacizumab in the study group, it was not a randomised controlled study.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic propranolol for prevention of ROP and visual outcome at 1 year (PreROP trial)

Sanghvi

Kabra

Padhi

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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Oral Propranolol: A New Treatment for Infants with Retinopathy of Prematurity?

Abstract: interventional studies are required to determine the clinical benefit-risk ratio of oral propranolol to prevent vision-threatening ROP in very preterm infants.

Cited by 19 publications

References 23 publications

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

Prophylactic propranolol for prevention of ROP and visual outcome at 1 year (PreROP trial)

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