Treatment of children and adolescents with hemangioma using propranolol: preliminary results from a retrospective study

Abstract

CONTEXT AND OBJECTIVE: Hemangiomas are the commonest vascular tumors during childhood. In 2008, the effect of propranolol for treating capillary hemangiomas was demonstrated. Other similar results followed, showing that it rapidly reduces lesion volume. The objective here was to evaluate children and adolescents with hemangiomas that were treated with propranolol. DESIGN AND SETTING: Retrospective study, conducted in a children's hospital. METHODS: Patients aged 0-19 years with or without previous treatment, who were treated between January 2009 and December 2010, were included. The response was assessed by comparing the lesion appearance between the start of treatment and the last consultation. We considered partial or complete responses as the response to treatment. RESULTS: Sixty-nine patients with a median follow-up of 11 months (mean age: 31 months) were included. Of these, 58 patients were recently diagnosed and 11 had had previous treatment. A response (partial or complete) was seen in 60 patients (87%). Among the capillary hemangioma cases, responses were seen in 50 out of 53 (94%), while in other lesion types, it was 10 out of 16 (63%) (P = 0.3; chi-square).Responses in patients less than one year of age were seen in 37 out of 38 (97%), whereas in those over one year of age, in 23 out of 31 (74%) (P = 0.4; chi-square). Side effects were uncommon and mild. CONCLUSIONS: Propranolol seemed to be effective for treatment of hemangiomas in children and adolescents, and not just in the proliferative stage, with responses in almost all the patients. Resposta (parcial ou completa) foi verificada em 60 pacientes (87%). Entre os hemangiomas capilares, a resposta foi de 50 em 53 (94%), enquanto em outros tipos de lesões, a resposta foi de 10 em 16 (63%) (P = 0,3; teste de qui-quadrado). A resposta em pacientes com até 1 ano de idade foi de 37 em 38 (97%), e naqueles com mais de 1 ano foi de 23 em 31 (74%) (P = 0,4; qui-quadrado). Efeitos colaterais foram incomuns e leves. CONCLUSÕES: Propranolol parece ser efetivo no tratamento de hemangiomas em crianças e adolescentes, não apenas na fase proliferativa, com resposta em quase todos os pacientes. RESUMO

Treatment of infantile hemangioma with propranolol: A review of 25 cases

“…In a study with two groups of patients, 37 out of 38 patients showed response to propranolol who started treatment before reaching the age of one year (97%), whereas the proportion was 23 out of 31 patients who started treatment after reaching one year of age (74%). 21 Our patient population was all in the proliferative stage or near its end. The previous study could suggest that propranolol could be a valuable medical treatment for cases presented late after the end of the proliferative stage.…”

“…27,28 Slowly increasing the dose of the drug and close monitoring of heart rate, blood pressure, and serum glucose levels have also been recommended in the initial phase of treatment. 27,28 Albuquerque et al 21 reported their results with 69 patients with hemangiomas treated with propranolol. They reported no cases needed to discontinue propranolol due to serious or intolerable side effects.…”

“…Taking into consideration that the patient population in the previous study was up to 19 years old and they used doses up to 4 mg/Kg. 21 Georgountzou et al 26 admitted their patients for 24 hours for heart rate and blood pressure monitoring every hour for 6 h following each dose (twice daily) and blood glucose testing 1h after each dose. They also recorded the heart rate and blood pressure after one week then monthly.…”

Treatment of infantile hemangioma with topical timolol maleate

“…Posteriormente, segue-se um período de estabilidade ou platô, que persiste por alguns meses, culminando em uma fase de involução lenta, que se inicia, em geral, entre 12 e 18 meses de vida. 1,3,[5][6][7] Estima-se que a involução completa ocorra ao ritmo de 10% ao ano, 2 e lesões remanescentes após o 6º ano de vida cursam com alterações residuais, como telangiesctasias, atrofias, cicatrizes e áreas de alopecia. 5 O diagnóstico, na maioria dos casos, é clínico.…”

Infantile Hemangioma

“…35 In contrast to corticosteroids, propranolol is effective in treating hemangiomas in children of all ages, and not limited to the proliferative stage of the lesions. 36 The recommended dose is 1 to 3 mg/kg/day divided in three doses. 37 Clinical improvement is evident in the majority of patients within the first week of treatment.…”