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Therapeutic superiority of combined propranolol with short steroids course over propranolol monotherapy in infantile hemangioma

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Abstract

Infantile hemangiomas are the most common benign childhood tumor that may have functional and/or cosmetic complications. We aimed to compare the clinical efficacy of propranolol alone and propranolol primed with systemic corticosteroids on the outcome of infantile hemangioma. A prospective randomized study included 40 infants aged less than 9 months with cutaneous hemangiomas. Patients were randomly assigned into two groups: group A were given oral prednisolone for the initial 2 weeks combined with oral propranolol, while group B were given oral propranolol alone for 6 months. The median age of the studied patients was 4.5 months (ranged 4 weeks–8 months). Sequential determination of the dimensions of the hemangiomas based on direct measurement and photographic analysis were performed. A significant reduction in the size of the lesions was found in group A in the 2-, 4-, and 8-week evaluation compared to group B (p < 0.001) with no statistical difference in the ultimate 6 month response (p = 0.134). Multiple logistic regression showed that early treatment before 6 months of age (OR 9.82, p = 0.007) and combined treatment with propranolol and prednisolone (OR 10.71, p = 0.006) were the predictors of best response.

Conclusion: Combining propranolol with corticosteroids gives a faster response and should be considered in treating life- or function-threatening hemangiomas.

What is Known:

• Steroids monotherapy was replaced by propranolol monotherapy in the practice of treatment of IH. Variable resistance to each of the two medications has been reported.

What is New:

• This randomized trial revealed that priming propranolol therapy with a short prednisolone course showed a faster response in complicated IH with minimal side effects.

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Abbreviations

IH:

Infantile hemangioma

PHACE:

Posterior fossa anomalies-hemangioma-arterial malformations-cardiac anomalies-eye anomalies

VEGF:

Vascular endothelial growth factor

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Conflict of interest

The authors declare that they have no conflict of interest.

Authors’ contributions

Mohamed M.D. Aly wrote the protocol, collected the data, shared in analysis of results and the literature searches; Alaa F. Hamza put the idea and designed the study; Hesham M. Abdel Kader shared in study design, data analysis, interpretation and revision of the manuscript; Hatem A. Saafan shared in data interpretation; Mohamed S. Ghazy performed the radiologic evaluations of the enrolled patients; Iman A. Ragab shared in data analysis and interpretation, wrote the first draft of the manuscript, and managed the literature searches.

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Authors and Affiliations

  1. Pediatric Surgery Department, Ain Shams University, Cairo, Egypt

    Mohamed M. D. Aly, Alaa F. Hamza, Hesham M. Abdel Kader & Hatem A. Saafan

  2. Radiodiagnosis Department, Ain Shams University, Cairo, Egypt

    Mohamed S. Ghazy

  3. Hematology-Oncology Unit, Pediatric Department, Ain Shams University, Abbasseya Square, Cairo, Egypt

    Iman A. Ragab

Authors
  1. Mohamed M. D. Aly
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  2. Alaa F. Hamza
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  3. Hesham M. Abdel Kader
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  4. Hatem A. Saafan
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  5. Mohamed S. Ghazy
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  6. Iman A. Ragab
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Corresponding author

Correspondence to Iman A. Ragab.

Additional information

Communicated by Jaan Toelen

Revisions received: 18 January 2015/03 May 2015

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Aly, M.M.D., Hamza, A.F., Abdel Kader, H.M. et al. Therapeutic superiority of combined propranolol with short steroids course over propranolol monotherapy in infantile hemangioma. Eur J Pediatr 174, 1503–1509 (2015). https://doi.org/10.1007/s00431-015-2561-1

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  • DOI: https://doi.org/10.1007/s00431-015-2561-1

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