Propranolol versus Prednisone in the Treatment of Infantile Hemangiomas: A Retrospective Comparative Study

Bertrand, Janie; McCuaig, Catherine; Dubois, Josée; Hatami, Afshin; Ondrejchak, R N Sandra; Powell, Julie

doi:10.1111/j.1525-1470.2011.01551.x

Cited by 74 publications

(66 citation statements)

References 17 publications

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“…Regarding distribution of Infantile hemangioma in different parts of the body 67.34% were in head-neck and face (face, orbital/periorbital, scalp, lip) region in our study which were cosmetically very much important site. In Anand Pandeyet al2009 study most of cases lesions were in head and face region (64.9%) 10 . According to Sans et al2009, Smithers and Fishman.2010 most of the lesion were in the same area 60% and 63% respectively 11 .…”

Section: Discussionmentioning

confidence: 99%

Oral Propranolol and Prednisolone in the Treatment of Infantile Hemangioma: A Comparative Study

Haque¹,

Ferdous

Saha³

et al. 2014

Chatt Maa Shi Hosp Med Coll J

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Purpose: Infantile Hemangioma is a common vascular tumor of infancy and children. Although the lesions involute, the results are unpredictable and the time taken is variable. Responses to commonly used drugs like corticosteroid are not satisfactory due to variable effectiveness. There are also hazards of surgical intervention. The aim of this study is to compare the oral propranolol & prednisolone for IH treatment. Methods: In this study 104 patients were included. They were divided into 2 groups by systematic sampling method. In Group-A 52 patients were treated with oral propranolol and in Group-B 52 patients with oral prednisololne as per the protocol at a dose of 2mg/kg/day in two divided doses. Measurements of the size (directly measured by soft flexible rubber tape and calipers) and color assessment (image based by Adobe Photoshop software) were recorded before starting of the treatment. Follow up was done on 15 th day, after 1 st , 2 nd , 3 rd and 4 th month respectively. Evaluation of percentage of regression of size and color clearance, adverse effects and treatment cost was done at each follow up. Regression in the size and color clearance of IHs was clinically assessed. Data were analyzed with the help of SPSS. P value of < .05 was considered significant. Results: In group-A 42(80.76%) had an excellent response, compared to group-B only 5(9.61%).In group-A, 40(76.92%) had an excellent color clearance, compared to group-B where only 03(05.76%). Regarding adverse effects in group-A, only 08 children (15.38%) complained of mild adverse effects which were self-limiting compared tothat of group-B (47,90.38%). In group-A average treatment cost was 165tk/ patient and in group-B 580tk. During follow up in group-A one case relapse was seen, in group-B 8 patient. Conclusion: Propranolol was safe, more effective and economic than oral prednisolone.

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Section: Discussionmentioning

confidence: 99%

Oral Propranolol and Prednisolone in the Treatment of Infantile Hemangioma: A Comparative Study

Haque¹,

Ferdous

Saha³

et al. 2014

Chatt Maa Shi Hosp Med Coll J

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“…Three studies used a visual analog scale. 22,24,28 Ten studies used a subjective rating of response (eg, good, fair, poor; complete, partial, no response), typically with a percentage improvement related 3 15,16,18,20,23,25,26,[29][30][31] Two studies rated improvement as greater or less than either 50% 32 or 75%. 21 The additional studies reported percent reduction, 27 change in total surface area, 19 or mean percentage decrease in size.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…18 Two RCTs and 2 cohort studies compared oral propranolol (2.0-2.7 mg/kg/day) and oral prednisolone or oral prednisone (2-4 mg/kg/day). [19][20][21][22] One cohort study compared oral propranolol (2 mg/kg/day) and intralesional bleomycin (0.5 mg/kg) 23 ; and 1 RCT and 1 cohort study evaluated oral propranolol (2-3 mg/kg/day) and other β-blockers (1-4 mg/kg/ day). 24,25 Three cohort studies and 2 RCTs assessed topical timolol (0.5%) compared with placebo or observation or another agent, [26][27][28][29][30] and 1 RCT and 1 cohort study evaluated different steroids, including oral prednisone and intralesional triamcinolone.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…17 Fourteen studies explicitly reported using masked assessors to rate changes in IH. [15][16][17][19][20][21][22]24,25,27,[29][30][31][32] All studies included IH in multiple anatomic locations, and lesion types (when reported) also varied, with the exception of most studies of topical timolol, which generally included only superficial lesions. Supplemental Table 5 outlines key study characteristics.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…31,32 Studies included a total of 1265 children with IH (ages ranging from 2 weeks to 9 years), and most were fair quality. [16][17][18][20][21][22]25,28,30 Studies compared pre-and posttreatment photographs to assess improvement in IH and reported change using varied metrics. Three studies used a visual analog scale.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

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Pharmacologic Interventions for Infantile Hemangioma: A Meta-analysis

Chinnadurai¹,

Fonnesbeck

Snyder

et al. 2016

Pediatrics

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STUDY SELECTION: Two reviewers assessed studies using predetermined inclusion criteria. DATA EXTRACTION:One reviewer extracted data with review by a second. RESULTS:We included 18 studies in a network meta-analysis assessing relative expected rates of IH clearance associated with β-blockers and steroids. Oral propranolol had the largest mean estimate of expected clearance (95%; 95% Bayesian credible interval [BCI]: 88%-99%) relative to oral corticosteroids (43%, 95% BCI: 21%-66%) and control (6%, 95% BCI: 1%-11%). Strength of evidence (SOE) was high for propranolol's effects on reducing lesion size compared with observation/placebo. Corticosteroids demonstrated moderate effectiveness at reducing size/volume (moderate SOE for improvement in IH). SOE was low for effects of topical timolol versus placebo. LIMITATIONS:Methodologic limitations of available evidence may compromise SOE. Validity of meta-analytic estimates relies on the assumption of exchangeability among studies, conditional on effects of the intervention. Results rely on assumed lack of reporting bias. CONCLUSIONS:Propranolol is effective at reducing IH size compared with placebo, observation, and other treatments including steroids in most studies. Corticosteroids demonstrate moderate effectiveness at reducing IH size/volume. The meta-analysis estimates provide a relative ranking of anticipated rates of lesion clearance among treatments. Families and clinicians making treatment decisions should also factor in elements such as lesion size, location, number, and type, and patient and family preferences. Dr Chinnadurai contributed to the conceptualization and design of the original review and meta-analysis and helped assess studies, verify data, develop the analysis, and draft the initial manuscript; Dr Fonnesbeck contributed to the conceptualization and design of the original review and meta-analysis, conducted the metaanalysis, and helped verify data and draft the initial manuscript; Drs Likis and McPheeters contributed to the conceptualization and design of the original review and meta-analysis and helped assess studies, develop the analysis, and draft the initial manuscript; Drs Morad and Snyder contributed to the conceptualization and design of the original review and meta-analysis and helped assess studies, verify data, develop the analysis, and draft the initial manuscript; Ms Sathe contributed to the conceptualization and design of the original review and meta-analysis and helped evaluate studies, extract and verify data, develop the analysis, and draft the initial manuscript; and all authors approved the fi nal manuscript as submitted. Infantile hemangiomas (IH) are the most common tumors of childhood. IH are benign but possess potential for permanent local tissue damage, ulceration, infection, bleeding, functional impact, and pain. Because of historical inconsistencies in naming conventions, the true prevalence of IH is unclear, but it is estimated that they affect ∼4% to 5% of children, 1 with higher prevalence in females and Caucasians. 2,3 ...

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Infrared Thermography to Assess Proliferation and Involution of Infantile Hemangiomas

et al. 2014

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IMPORTANCEInfantile hemangiomas (IHs) are common benign tumors of infancy that have the potential to interfere with vital organ function and cause permanent disfigurement. Currently, few objective and validated measures exist to assess IHs.OBJECTIVE To determine the utility of infrared thermography in assessing and monitoring the growth of IHs. DESIGN, SETTING, AND PARTICIPANTSIn a prospective cohort study conducted at an outpatient dermatology clinic of a tertiary care hospital between February 2011 and December 2012, a convenience sample of 42 infants aged 0 to 6 months with an IH were enrolled. The mean age of the study group was 3.7 months, with the majority of IHs being mixed type (57%) affecting the head and neck (81%). Of the infants, 36 (86%) were receiving active treatment during the study period, and patients were followed for a minimum of 3 clinical visits, at least 1 month apart. MAIN OUTCOMES AND MEASURESAbility of infrared thermography to assess the proliferation and involution of IHs compared with a visual analog scale. Secondary outcomes were reliability, ease of use, and parental acceptance of the instrument. RESULTSThe mean temperature difference at baseline was 1.9°F (95% CI, 1.2°F to 2.7°F), which peaked at 3 months to 2.5°F (95% CI, 0.8°F to 4.2°F), and decreased progressively to 0.2°F (95% CI, −1.1°F to 1.4°F) at 18.5 months (P < .001). This change in temperature was inversely correlated with mean visual analog scale (r = −0.25). Mean temperature differences recorded at baseline and 30 minutes later were not significant (least squares mean baseline temperature, 87.9°F [95% CI, 87.4°F to 88.3°F], vs least squares mean temperature after 30 minutes, 88.1°F [95% CI, 87.7°F to 88.6°F] [P = .14]). Multivariate analysis demonstrated facial location (F 1,365 = 47.63, P < .001), IH type (F 2,365 = 3.26, P = .04), age (F 2,365 = 7.03, P = .001), and surface area at baseline (F 2,365 = 8.18, P < .001) as factors significantly affecting temperature difference over time. Only IH type (Wald χ 2 2 = 6.79, P = .03) and treatment (Wald χ 2 1 = 4.29, P = .04) significantly affected time to reach a zero-temperature difference. All caregivers (100%) reported IRT to be easy to implement, quick to perform, and comfortable for their child.CONCLUSIONS AND RELEVANCE Infrared thermography is a reliable and valid measure of IH growth that is noninvasive, convenient, and well tolerated by infants, making it well suited to daily clinical practice. It has the potential to provide real-time objective results that can be used for routine monitoring and evaluating treatment efficacy.JAMA Dermatol. 2014;150(9):964-969.

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Propranolol versus Prednisone in the Treatment of Infantile Hemangiomas: A Retrospective Comparative Study

Cited by 74 publications

References 17 publications

Oral Propranolol and Prednisolone in the Treatment of Infantile Hemangioma: A Comparative Study

Oral Propranolol and Prednisolone in the Treatment of Infantile Hemangioma: A Comparative Study

Pharmacologic Interventions for Infantile Hemangioma: A Meta-analysis

Infrared Thermography to Assess Proliferation and Involution of Infantile Hemangiomas

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