Rebound Growth of Infantile Hemangiomas After Propranolol Therapy

Abstract

Rebound growth occurred in 25% of patients, requiring modification of systemic therapy in 15%. Predictive factors for rebound growth included age of discontinuation, deep IH component, and female gender. Patients with these predictive factors may require a prolonged course of therapy.

Efficacy of Propranolol Between 6 and 12 Months of Age in High-Risk Infantile Hemangioma

“…18 The rate of rebound growth (32%) was consistent with that of previous reports. 18,19 However, the proportion of patients who were judged as requiring retreatment in our study (24%) was higher than in the retrospective studies (15% 19 and 12% 18 of patients required retreatment or modification of systemic therapy) and the pivotal study (10% 13 of patients required retreatment). However, these studies were not restricted to high-risk IH patients only, who are more likely to require treatment.…”

“…13 Therefore, we evaluated the efficacy and safety of oral propranolol in patients with high-risk IH when administered for a minimum of 6 months and up to a maximum of 12 months of age. Furthermore, because rebound growth is reported in ∼25% of patients after stopping propranolol, 18,19 the persistence of IH response and the efficacy of retreatment was evaluated along with the impact of treatment on parents' quality of life (QoL).…”

Hemangiomas and β-Blockers: On the Rebound

“…The findings of Shah et al 10 confirm the findings of others, and expand our understanding of this phenomenon. Their finding of increased rebound in deep or mixed IH and segmental IH is consistent with other reports, [6][7][8] as is the increased risk of rebound observed in girls 2,[6][7][8] The aforementioned hemangioma subtypes may represent a unique subpopulation of IH programmed to proliferate longer.…”

“…11,12 In a series of IH with prolonged growth by Brandling-Bennett et al, 11 all 23 lesions were on the head and neck, another feature found in the current study; in that series, nearly 40% of IH involved the parotid gland, a detail not included in the current report. The data from Shah et al 10 expand the published observations on rebound as a function of duration of OP therapy and age at the time of discontinuation or taper. Several previous studies report a higher rebound rate with shorter durations of OP therapy, 2, 6, 13 although in others this association is less clear.…”

“…In this issue, Shah and colleagues 10 report their findings of a retrospective cohort study of 980 patients with IH treated with OP, in which they assessed the incidence of rebound growth, IH characteristics, and treatment factors. They distinguished major rebound growth (need for dose adjustment or treatment reinitiation) from minor rebound growth (no change in therapy necessary), and used a visual analog scale as a proxy for IH response.…”