Propranolol Therapy in 55 Infants with Infantile Hemangioma: Dosage, Duration, Adverse Effects, and Outcome

Abstract

Propranolol has recently been reported to be a highly effective treatment for infantile hemangioma (IH) and is emerging as a first-line therapy. This study reports the observations after completed propranolol therapy in 55 patients. Propranolol was administered in a dosage of 2 mg/kg per day with initial monitoring of vital signs. Therapy duration was planned for 4 to 6 months; if there was significant relapse, the period of treatment was extended. The mean age of 55 patients at the beginning of the treatment was 6 months (52.7% <4 mos, 30.9% 4-9 mos, 16.3% >9 mos). Thirteen patients (21.7%) showed a reaction possibly due to the medication, but we did not observe any life-threatening adverse effects. The therapy was interrupted due to temporary aggravation of preexisting bronchial asthma in one child. The initially administered dosage was adjusted to the increase of weight in 21 patients (38.2%), but most did not require a dosage adjustment despite somatic growth. Mean duration of treatment was 6 months; younger patients needed longer treatment periods. Response to treatment was favorable; eight (14.5%) showed total regression and 46 (83.4%) partial regression, and one (1.8%) had no response. Propranolol is an efficacious therapy for severe IH. Risks and complications appear moderate. If indicated, therapy should be initiated early to minimize the extent of residual changes. Young patients show quick and extended benefit. Prospective controlled trails are necessary to observe the effects on a long-term basis.

The role of propranolol in the treatment of infantile hemangioma

“…38 In our series, propranolol improved esthetics in all patients, giving scope for more conservative surgical intervention in the future if necessary. These findings are consistent with those reported by Zvulunov et al, 39 Schupp et al 36 and Celik et al, 21 who reported the results of propranolol therapy for hemangiomas beyond the proliferative phase, and imply that oral propranolol therapy may be warranted in children with late residual infantile hemangiomas, prior to any surgical intervention. 21 Still, the most impressive responses occurred in the youngest patients, a finding that is consistent with the natural history of hemangioma, in which 80% of its size is reached by six months of age, and justifies referring such cases earlier for optimal therapeutic response.…”

“…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.…”

Perioküler Bölge Hemanjiyomlarının Tedavisinde Güncel Yaklaşımlar

“…19 Bu tesadüfi buluş sayesinde kapiller cilt hemanjiom tedavisinde yeni bir çığır açılmıştır ve bir non-selektif beta bloker ajan olan propranololün hem sistemik, hem de topikal kullanımı konusunda pek çok sayıda araştırma yapılmaya başlanmıştır. 2,5,12,16,[18][19][20] Tam etki mekanizması bilinmese de propranololün pek çok farklı yolakları etkiliyor olması muhtemeldir. İlaç verildikten sonra en dramatik cevap ilk haftada, lezyonda yumuşama, küçülme, solma gibi belirtiler ile kendini gösterir.…”

“…İlaç verildikten sonra en dramatik cevap ilk haftada, lezyonda yumuşama, küçülme, solma gibi belirtiler ile kendini gösterir. 16,18,19 Lezyondaki solma ve yumuşama ilacın vazokonstrüksiyonu tetikleyici etkisine bağlanırken, progresyonu durdurucu ve apoptozisi indükleyici etkisi ise büyüme faktörlerinin seviyesini azaltmasıyla açıklamaktadır. 4 Bu ucuz ve kolay bulunabilir ilaç 2 mg/kg (Dideral, Sanofi) dozunda günde 2-3 defaya bölünerek verilmektedir.…”

“…4 Bu ucuz ve kolay bulunabilir ilaç 2 mg/kg (Dideral, Sanofi) dozunda günde 2-3 defaya bölünerek verilmektedir. 16,18,19,21 Etkinliği arttırmak için tedricen 4 mg/kg/gün tedavi dozuna çıkılabileceği de bildirilmiştir. Bazı otörler ilk bir kaç dozu hastane ortamında vermeyi tercih etse de tedavinin tamamını ayaktan yapan yazarlar da mevcuttur.…”