Propranolol for Severe Infantile Hemangiomas: Follow-Up Report

Sans, Véronique; Roque, Eric Dumas de la; Berge, Jérôme; Grenier, N.; Boralévi, F.; Mazereeuw‐Hautier, J.; Lipsker, Dan; Dupuis, Elisabeth; Ezzedine, Khaled; Vergnes, P; Taı̈eb, Alain; Léauté‐Labrèze, Christine

doi:10.1542/peds.2008-3458

Cited by 519 publications

(506 citation statements)

References 27 publications

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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.…”

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confidence: 99%

β-Adrenergic receptor expression in vascular tumors

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β-Adrenergic receptor expression in vascular tumors

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“…9,11,17---19,21,22,28---37 There is also no consensus regarding the relapse rate after discontinuation, with some studies showing no relapses, 30---32 while others report minor recurrences. 17,18,36 In our short series only one of the patients in whom propranolol was tapered showed a slight, non-significant, relapse, with no need to re-start treatment.…”

Section: Discussionmentioning

confidence: 58%

“…18,19 The potential side effects of beta-blockers, which are well known and include bradycardia, hypotension, and hypoglycemia, 11,18,33,40---44 must be borne in mind.…”

Section: Discussionmentioning

confidence: 99%

“…18,45 Notwithstanding, propranolol appears to be a safe drug when correctly administered. No adverse effects were observed in our series; none of our patients had symptoms of hypoglycemia or hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, current therapeutic approaches have limited success and significant adverse effects that limit their use. 12---16 Since Léauté-Labrèze's accidental observation 17 of the anti-proliferative effect of propranolol on infantile hemangiomas, propranolol has become increasingly popular 18,19 as a successful therapeutic option, with fewer side effects than other treatments.…”

Section: Introductionmentioning

confidence: 99%

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The role of propranolol in the treatment of infantile hemangioma

Laranjo

Costa

Paramés

et al. 2014

Revista Portuguesa de Cardiologia

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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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Propranolol vs Corticosteroids for Infantile Hemangiomas

Price¹

2011

Arch Dermatol

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109

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Patients: The study included 110 patients with IHs. Main Outcome Measures: The percentage of clearance was quantified by documented serial global photography and clinical examinations (length, height, and width) to segregate patients into 2 groups: patients who had clearance of 75% or more and patients who had less than 75% clearance. Results: The mean duration of treatment was 7.9 months for propranolol and 5.2 months for oral corticosteroids. Fifty-six of 68 patients (82%) who were receiving propranolol achieved clearance of 75% or more compared with 12 of 42 patients (29%) who were receiving oral corticosteroids (PϽ .01). Adverse effects were minimal in the propranolol group: 1 patient had hypoglycemia and 2 patients had a nonspecifice skin eruption that was not associated with propranolol therapy. All 42 patients in the corticosteroid group had 1 or more adverse effects (P Ͻ.01). Relapse after discontinuation of propranolol therapy occurred in 2 of the 68 patients; however, both patients responded to propranolol therapy on reinitiation of treatment. Surgical referrals after treatment were required in 8 patients (12%) in the propranolol group and 12 patients (29%) in the oral corticosteroid group (P Ͻ.01). Conclusions: Propranolol therapy was more clinically effective and more cost-effective than oral corticosteroids in treating IHs. It also resulted in fewer surgical interventions and demonstrated better tolerance, with minimal adverse effects, compared with oral corticosteroids. Therefore, propranolol should be considered a first-line agent given its safety and efficacy in the treatment of IHs.

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Propranolol for Severe Infantile Hemangiomas: Follow-Up Report

Abstract: Propranolol administered orally at 2 to 3 mg/kg per day has a consistent, rapid, therapeutic effect, leading to considerable shortening of the natural course of IHs, with good clinical tolerance.

Cited by 519 publications

References 27 publications

β-Adrenergic receptor expression in vascular tumors

β-Adrenergic receptor expression in vascular tumors

The role of propranolol in the treatment of infantile hemangioma

Propranolol vs Corticosteroids for Infantile Hemangiomas

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