The effectiveness of propranolol in treating infantile haemangiomas: a meta‐analysis including 35 studies

Abstract

AIMSPropranolol may have shown excellent results as a first line therapy in infantile haemangiomas (IHs) at all sites in the body, but this conclusion remains controversial. In an attempt to resolve this issue, we performed a meta-analysis. METHODSA search of the literature using PubMed, MEDLINE, Cochrane Library databases and China National Knowledge Infrastructure (CNKI) was performed to identify studies which estimated the efficacy of propranolol therapy in infants with haemangiomas all sites of the body. The pooled odds ratio (OR) along with the corresponding 95% confidence intervals (CI) were assessed using a fixed effects model. RESULTSThirty-five studies involving 324 infantile haemangioma(IH) patients and 248 controls were retrieved and analyzed. The efficacy of propranolol was greater than other therapies in treating IHs (OR = 9.67, 95% CI 6.62, 14.12, P < 0.001). In a stratified analysis by sites of tumour, propranolol was a more effective therapy when compared with steroids (OR = 9.67, 95% CI 6.61, 14.15, P < 0.001), vincristine (OR = 9.00, 95% CI 2.15, 37.66, P = 0.003) and laser treatment (OR = 9.00, 95% CI 1.42, 57.12, P = 0.020) in treating cutaneous IHs (OR = 24.95, 95% CI 9.48, 65.64, P < 0.001), peri-ocular IHs (OR = 9.39, 95% CI 3.88, 22.71, P < 0.001), infantile airway haemangiomas (OR = 20.91, 95% CI 7.81, 55.96, P < 0.001) and infantile hepatic haemangiomas (OR = 9.89, 95% CI 1.20, 81.54, P = 0.033). CONCLUSIONThe current meta-analysis provided strong evidence for propranolol as a first line therapy for IHs. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Propranolol has shown excellent results in treating infantile hemangiomas of all sites of the body, but this conclusion remains controversial. WHAT THIS STUDY ADDS• This meta-analysis has provided strong evidence that propranolol is better than other treatment modalities for the resolution of infantile hemangiomas of all sites of the body for the first time.

Regression of Large Infantile Multifocal Hepatic Hemangioma after Propranolol

“…MRI plays an important role in the correct diagnosis [2,3]. In the last years the use of propranolol has scattered and actually many practitioners have adopted it as first line of therapy [3][4][5]. …”

A case of giant fetal intracranial capillary hemangioma cured with propranolol

“…Subsequently, many authors began to examine propranolol and its role in capillary hemangioma treatment and have suggested this beta-blocker as a first-line treatment for severe infantile capillary hemangiomas. 12,15,24 Propranolol is a nonselective beta-adrenergic receptor antagonist that appears to promote vasoconstriction in capillary hemangiomas, reducing blood flow within these lesions and causing skin capillary hemangiomas to change color and soften. This beta-blocker appears to inhibit angiogenesis by decreasing the expression of proangiogenic growth factors, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), most likely by inactivating the extracellular signal-related kinase/mitogen-activated protein kinase (ERK/MAPK) cascade.…”

“…3,4,13,25 A different scenario is applicable for cutaneous hemangiomas. 12,15,24 In particular, for such tumors, propranolol has been the first-line treatment since Léauté-Labrèze et al 10 published a case series in 2008 that described severe infantile hemangiomas treated with this beta-blocker with excellent outcomes. To date, propranolol has not been described as a treatment for intracranial capillary hemangiomas.…”

Infantile Hemangioma

“…31 Lou et al performed a meta-analysis on 35 studies that estimated the efficacy of propranolol therapy involving 423 patients with infantile hemangiomas and 248 control subjects. 32 The authors found that efficacy of propranolol was Pediatr Neonatal Nurs Open J more than other therapies in treating infantile hemangiomas (odds ratio:9.67; 95% confidence interval:6.62 to 14.12; P<0.001). In stratified analysis by sites of tumor, propranolol was more effective when compared to corticosteroids (odds ratio: 9.67; 95% confidence interval: 6.61 to 14.15; P<0.001), vincristine (odds ratio: 9; 95% confidence interval: 2.15 to 37.66; P=0.003), and laser (odds ratio: 9; 95% confidence interval:1.42 to 57.12; P=0.02) in treating cutaneous infantile hemangiomas (odds ratio: 24.95; 95% confidence interval:9.48 to 65.64; P<0.001), periocular infantile hemangiomas (odds ratio:9.39; 95% confidence interval: 3.88 to 22.71; P<0.001), airway infantile hemangiomas (odds ratio: 20.91; 95% confidence interval: 7.81 to 55.96; P<0.001), and hepatic infantile hemangiomas (odds ratio: 9.89; 95% confidence interval: 20.81 to 81.54; P=0.033).…”