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Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas

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Abstract

Beta-blockers are a highly promising treatment modality for complicated infantile hemangiomas (IH). However, data on propranolol as first-line treatment, objective outcome measures and impact on hemodynamics in young infants is limited. We retrospectively evaluated a homogenous group of infants with proliferating complicated IH treated with propranolol (2 mg/kg/day). Outcome was assessed by blinded evaluation of clinical photographs by visual analogue scale (VAS), ultrasound examination and ophthalmological review (if appropriate). Tolerance and hemodynamic variables were recorded over time, including a 2-day in-patient observation at the initiation of therapy. Twenty-five infants (median age 3.6 (1.5–9.1) months) were included in the study. The median follow-up-time was 14 (9–20) months and 14 patients completed treatment at a median age of 14.3 (11.4–22.1) months, after a duration of 10.5 (7.5–16) months. In all patients, there was significant fading of colour (with a VAS of −9 (−6 to −9) after 7 months) and significant decrease in size of the IH (with a VAS of −8 (−3 to −10) after 7 months). Median thickness of the lesions assessed by ultrasound at baseline and after 1 month was 14 (7–28) mm and 10 (5–23) mm, respectively (p < 0.01). In children with periocular involvement, astigmatism and amblyopia resolved rapidly within 8 weeks. The overall tolerance of propranolol was good, and no relevant hemodynamic changes were noted. Conclusion: Our report supports the excellent effect and good tolerance of this novel therapy, and we propose the use of propranolol as first-line treatment for IH.

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Acknowledgments

We thank Valérie Jaquet and Gabriela Acklin (Photographers, University Children’s Hospital) for performing the photographic documentation of this study. We gratefully acknowledge Dr. Stephan Nobbe (Dermatologist, University Hospital Zurich) for reviewing and scoring the patient’s photographs and Dr. Alain Rudiger (Internal Medicine, University Hospital Zurich) for his statistical advise.

Statement of all funding sources that supported the work: LW was supported by non-restricted grants from the Stiefel-Zangger Foundation and UBS Foundation of the University Children’s Hospital of Zurich.

Conflict of Interest

The study was sponsored by departmental funds. Dr. Lisa Weibel was supported by non-restricted grants from the Stiefel-Zangger Foundation and UBS Foundation of the University Children’s Hospital of Zurich. She also received honoraria for consulting activities from Laboratoires Pierre Fabre. LW has received honoraria for consulting activities for Laboratoires Pierre Fabre.

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Authors and Affiliations

  1. Division of Plastic Surgery, University Children’s Hospital Zurich, Zurich, Switzerland

    Clemens Schiestl, Kathrin Neuhaus, Silke Zoller & Ulrike Subotic

  2. Division of Radiology, University Children’s Hospital Zurich, Zurich, Switzerland

    Ishilde Forster-Kuebler

  3. Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland

    Rike Michels

  4. Division of Cardiology, University Children’s Hospital Zurich, Zurich, Switzerland

    Christian Balmer

  5. Division of Dermatology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Lisa Weibel

  6. Department of Dermatology, University Hospital Zurich, Zurich, Switzerland

    Lisa Weibel

Authors
  1. Clemens Schiestl
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  2. Kathrin Neuhaus
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  3. Silke Zoller
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  4. Ulrike Subotic
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  5. Ishilde Forster-Kuebler
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  6. Rike Michels
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  7. Christian Balmer
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  8. Lisa Weibel
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Corresponding author

Correspondence to Lisa Weibel.

Additional information

Clemens Schiestl and Kathrin Neuhaus contributed equally to this work

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Schiestl, C., Neuhaus, K., Zoller, S. et al. Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas. Eur J Pediatr 170, 493–501 (2011). https://doi.org/10.1007/s00431-010-1324-2

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  • DOI: https://doi.org/10.1007/s00431-010-1324-2

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