Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey

Abstract

Summary Background Oral propranolol is widely prescribed as first‐line treatment for infantile haemangiomas (IHs). Anecdotally, prescribing practice differs widely between centres. Objectives The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs. Methods Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool. Results The study cohort comprised 1097 children from 39 centres in eight European countries. 76·1% were female and 92·8% had a focal IH, with the remainder showing a segmental, multifocal or indeterminate pattern. The main indications for treatment were periocular location (29·3%), risk of cosmetic disfigurement (21·1%) and ulceration and bleeding (20·6%). In total 69·2% of patients were titrated up to a maintenance regimen, which consisted of 2 mg kg−1 per day (85·8%) in the majority of cases. 91·4% of patients had an excellent or good response to treatment. Rebound growth occurred in 14·1% upon stopping, of whom 53·9% were restarted and treatment response was recaptured in 91·6% of cases. While there was no significant difference in the treatment response, comparing a daily maintenance dose of < 2 mg kg−1 vs. 2 mg kg−1 vs. > 2 mg kg−1, the risk of adverse events was significantly higher: odds ratio (OR) 1 vs. adjusted OR 0·70, 95% confidence interval (CI) 0·33–1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04–5·46, P = 0·04, Ptrend < 0·001. Conclusions The PITCH survey summarizes the use of oral propranolol across 39 European centres, in a variety of IH phases, and could be used to inform treatment guidelines and the design of an interventional study.

Oral propranolol for infantile hemangiomas beyond the proliferative phase

“…There is no study which directly compares the 3 and 2 mg/kg per day propranolol regimens. According to the European cohort study, they found no difference in treatment response between 3 and 2 mg/kg per day . In their cohort, there was a clear association between the frequency of adverse events and the treatment dose, with twice the number of adverse events seen in the 3 mg/kg per day group compared with those receiving 2 mg/kg per day or lower doses .…”

Thirty‐two Japanese cases of infantile hemangiomas treated with oral propranolol

“…There is no study which directly compared the 3 mg/kg per day of propranolol regimen and the 2 mg/kg per day of propranolol regimen. According to the European propranolol in the treatment of complicated hemangiomas taskforce survey, the study cohort comprised 1097 patients from 39 centers in eight European countries and they found no difference in treatment response between 3 mg/kg per day and 2 mg/kg per day . In their cohort, there was a clear association between the frequency of adverse events and the treatment dose, with twice the number of adverse events seen in the 3 mg/kg per day group compared with those receiving 2 mg/kg per day or lower doses.…”

Oral propranolol in the treatment of proliferating infantile haemangiomas: British Society for Paediatric Dermatology consensus guidelines

“…As a first step to inform the treatment guidelines, we conducted an international survey of current practice in eight European countries, involving review of 1100 patients with IH on oral propranolol with regard to treatment efficacy and safety [Propranolol In the Treatment of Complex infantile Haemangiomas (PITCH) Taskforce] . This was followed by a systematic review of the literature and both were used to develop statements relating to the use of oral propranolol in the treatment of IH.…”

“…Despite the high frequency of propranolol use and potential complications, there are currently no U.K. guidelines for the treatment of IH with propranolol. Our recent European treatment survey indicated differing approaches to the management of IH, for instance with regard to pretreatment investigations, treatment dose, length of treatment, use in PHACES (posterior fossa malformations–haemangiomas–arterial anomalies–cardiac defects–eye abnormalities–sternal cleft and supraumbilical raphe) syndrome and cessation of treatment . In addition, many U.K. dermatology departments have formulated their own propranolol guidelines for the treatment of IH.…”

“…The purpose of the British Society for Paediatric Dermatology (BSPD) guidelines is to provide evidence‐based guidance on the use of propranolol in the treatment of IH, with a view to assisting clinical decision‐making and standardizing care. These guidelines are based on an international survey of how oral propranolol is currently used in clinical practice, a systematic review of the literature and a Delphi consensus process to produce specific guidance for practising clinicians …”