Treatment of superficial infantile hemangiomas with timolol: Evaluation of short-term efficacy and safety in infants

Lu, Yu; Li, Shengmiao; Su, Baoli; Liu, Zhengji; Fang, Jing-Jing; Zhu, Liqi; Huang, Minyan; Shan, Wangyong; Song, Daiqiang; Ye, Binbin; Luo, Chen

doi:10.3892/etm.2013.1176

Cited by 46 publications

(47 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Topical timolol has fewer side effects than systemic administration of β-blocker. 38 However, systemic absorption following topical application of timolol can occur, especially in young infants. Pruritus may occur at the application site.…”

Section: Managementmentioning

confidence: 99%

Infantile Hemangioma

Leung¹,

Barankin²,

Hon³

2014

Pediatr Neonatal Nurs Open J

View full text Add to dashboard Cite

Infantile hemangiomas typically appear in the first few weeks of life as areas of pallor, followed by telangiectatic patches. They then grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, and sharply demarcated and are often referred to as "strawberry hemangiomas". Deep lesions are bluish and dome-shaped, feel like a "bag of worms", and are compressible. Infantile hemangiomas have a predilection for the head and neck region. Most infantile hemangiomas exist as solitary lesions. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Half of these lesions will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by ages 10 to 12. The majority of infantile hemangiomas require no treatment. Indications for active intervention include severe or recurrent hemorrhage unresponsive to treatment, threatening ulceration in areas where serious complications might ensue, interference with vital structures, pedunculated hemangiomas, and significant disfigurement. Treatment options include systemic corticosteroids, intralesional corticosteroids, topical and oral beta blockers, pulsed-dye laser, and less commonly interferon-α or surgical resection. In recent years, propranolol, a nonselective β-blocker, has been preferentially used as a first-line treatment of problematic infantile hemangioma.

show abstract

Section: Managementmentioning

confidence: 99%

Infantile Hemangioma

Leung¹,

Barankin²,

Hon³

2014

Pediatr Neonatal Nurs Open J

View full text Add to dashboard Cite

show abstract

“…26,27 One study comparing ophthalmic timolol and imiquimod reported no differences in effects. 28 Two studies using laser as a comparator reported mixed results: no differences in average overall improvement in 1 study comparing timolol and timolol plus laser modalities 30 and greater response to timolol in superficial IH, with greater response of mixed IH to timolol plus laser in another.…”

Section: Figurementioning

confidence: 99%

“…[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. 31,32 Studies included a total of 1265 children with IH (ages ranging from 2 weeks to 9 years), and most were fair quality.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…We considered 4 studies as good quality 15,19,27,31 and 5 as poor quality. 23,24,26,29,32 Two investigators also graded the strength of the body of evidence (confidence in the estimate of effect) by using methods based on the Methods Guide for Effectiveness and Comparative Effectiveness Reviews. 36 The full team reviewed the final strength of evidence (SOE) designation with discussion to reach consensus as needed.…”

Section: Assessment Of Study Quality and Strength Of Evidencementioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pharmacologic Interventions for Infantile Hemangioma: A Meta-analysis

Chinnadurai¹,

Fonnesbeck

Snyder

et al. 2016

Pediatrics

View full text Add to dashboard Cite

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 ...

show abstract

Effect of topical timolol on response rate and adverse events in infantile hemangioma: a meta-analysis

Zheng

2018

Arch Dermatol Res

View full text Add to dashboard Cite

A number of clinical trials evaluated the effect of topical timolol in the treatment of infantile hemangioma and provided inconsistent results. The present study assessed the response rate and adverse events of topical timolol in the treatment of infantile hemangioma. Pubmed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, and Cochrane library were searched until October 2016. Specific inclusion criteria were used to evaluate articles. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The meta-analysis was performed using a random effect model. A total of 10 studies, comprising 887 infants with hemangioma, were included. The response rate was reported in eight trials; these studies compared the topical timolol to laser, observation, placebo, or propranolol. The heterogeneity was statistically significant (P < 0.00001, I = 83%). The difference in the response rate was significant (RR = 2.86, 95% CI 1.31-6.24) while comparing the topical timolol to the controls. However, no significant difference in the response rate was observed while comparing the topical timolol to propranolol (RR = 0.99, 95% CI 0.70-1.42). The difference in the adverse events was found to be significant (RR = 0.21, 95% CI 0.05-0.97) when the timolol group was compared to the control group. This meta-analysis confirmed that the topical timolol alone was more beneficial on response rate and adverse event than laser, placebo, and observation. The response rate did not differ significantly when comparing the topical timolol to propranolol. However, further studies are essential using an improved design of the study.

show abstract

Treatment of superficial infantile hemangiomas with timolol: Evaluation of short-term efficacy and safety in infants

Cited by 46 publications

References 9 publications

Infantile Hemangioma

Infantile Hemangioma

Pharmacologic Interventions for Infantile Hemangioma: A Meta-analysis

Effect of topical timolol on response rate and adverse events in infantile hemangioma: a meta-analysis

Contact Info

Product

Resources

About