Propranolol as First-Line Treatment for Infantile Hemangiomas

Holmes, William John; Mishra, Anuj; Gorst, Cath; Liew, Se Hwang

doi:10.1097/prs.0b013e3181c2a731

Cited by 44 publications

(36 citation statements)

References 4 publications

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“…3,5,6,8,9,[11][12][13][14][15] While cognizant of potential adverse reactions, particularly hemodynamic changes and hypoglycemia, we have been encouraged by the long history of this medication being generally well tolerated in patients of all ages when initiated in standard doses in the outpatient setting. 18 Further, an extensive review by Love and Sikka 16 in 2003 found that ''not one documented case of death or serious cardiovascular morbidity as a direct result of a beta-blocker exposure is to be found in an English language review for children under 6 years of age.''…”

Section: Discussionmentioning

confidence: 98%

“…In the brief time since that report, many physicians have become interested in exploring this new treatment option for periocular, 2-6 facial, 7 airway, [8][9][10][11][12] liver, 13 and other functional or disfiguring lesions. 14,15 Despite its long history and safety profile, 16 propranolol is not typically among the agents used by ophthalmologists to treat hemangiomas. Currently, a protocol for treatment of hemangiomas with propranolol does not exist; such a protocol should include a standard regimen for initial dosing, effective therapeutic dosage, guidelines for duration of treatment, consensus on appropriate pretreatment evaluation or protocol for initiating therapy, and standard regimen for discontinuing medication.…”

Section: Introductionmentioning

confidence: 99%

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Outpatient treatment of periocular infantile hemangiomas with oral propranolol

Haider

Plager

Neely

et al. 2010

Journal of American Association for Pediatric Ophthalmology and

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Outpatient treatment of periocular infantile hemangiomas with oral propranolol

Haider

Plager

Neely

et al. 2010

Journal of American Association for Pediatric Ophthalmology and

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“…25,26 A large international randomized clinical trial is underway, but many are already advocating its use as a first-line treatment for infantile hemangiomas, in terms of both safety and efficacy. 21,27 Its effects were first discovered by chance by Léauté-Labrèze et al in 2008. 17 Subsequent Figure 3 A ten-month-old boy with hemangioma on the right patella and upper right leg, showing a fair response after 18 months of therapy.…”

Section: Discussionmentioning

confidence: 99%

The role of propranolol in the treatment of infantile hemangioma

Laranjo

Costa

Paramés

et al. 2014

Revista Portuguesa de Cardiologia (English Edition)

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Introduction: Infantile hemangioma (IH) is one of the most common childhood tumors. There are various medical or surgical therapeutic options, all with suboptimal results. Recently, the successful use of propranolol for involution of IH was described. We report the results of a single-center experience with this therapeutic option. Objective: To prospectively assess the efficacy and safety of propranolol in children with infantile hemangioma. Methods:We performed a prospective analysis of clinical data of all patients with IH referred to a pediatric cardiology center for baseline cardiovascular assessment prior to propranolol therapy. Propranolol was given at a starting dose of 1 mg/kg/day and titrated to a target dose of 2---3 mg/kg/day according to clinical response. Efficacy was assessed through a photographbased severity scoring scale. Safety was assessed by collecting data regarding significant side effects. Results: Starting in 2010, 30 patients (15 female) were referred for propranolol treatment of IH, at a median age of six months (1---63 months). The mean target propranolol dose was 2.8 mg/kg/day, with a mean duration of therapy of 12 months. All patients experienced significant reduction of IH size and volume. There were no side effects. Conclusions: In our experience propranolol appears to be a useful and safe treatment option for severe or complicated IH, achieving a rapid and significant reduction in their size. No adverse effects were observed, although until larger clinical trials are completed, potential adverse events should be borne in mind and consultation with local specialists is recommended prior to initiating treatment. PALAVRAS-CHAVE Hemangioma infantil; Propranolol O papel do propranolol no tratamento dos hemangiomas em idade pediátrica ResumoIntrodução: Os hemangiomas são a lesão tumoral cutânea mais frequente em idade pediátrica. Até ao momento todas as opções terapêuticas (tanto médicas como cirúrgicas) têm resultados sub-ótimos. Recentemente, foi descrita a utilização de propranolol para tratamento dos hemangiomas. Relatamos os resultados da nossa experiência com esta opção terapêutica. Objetivo: Avaliação prospetiva da eficácia e segurança de propranolol em crianças com hemangioma infantil. Métodos: Avaliação prospetiva de todos os doentes com hemangioma referenciados para avaliação cardiovascular prévia ao início de terapêutica com propranolol. O propranolol foi administrado numa dose inicial de 1 mg/kg/dia e titulada para uma dose alvo de 2---3 mg/kg/dia, de acordo com a resposta clínica. A eficácia foi avaliada através de uma escala fotográfica. A segurança foi avaliada através da recolha de dados sobre os efeitos secundários significativos. Resultados: Desde 2010, 30 crianças (15 do sexo feminino) com hemangiomas foram referenciados para avaliação cardiovascular prévia ao início de terapêutica beta-bloqueante, com uma idade média de 6 meses (1-63 meses). A dose alvo média atingida foi de 2,8 mg / kg / dia, com uma duração média de tratamento de 12 meses. Em todos os doe...

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“…Since then, case studies and small series of infantile hemangiomas treated successfully with propranolol or other bblocking agents have been reported. [11][12][13][14][15][16][17] Three different b-adrenergic receptor (AR) subtypes are known definitively to exist: b1, b2, and b3. These b-ARs are G-protein-coupled receptors and are present on endothelial cells.…”

mentioning

confidence: 99%