According to a report published Online First by Archives of Dermatology, one of the JAMA/Archives journals, using the beta-blocker propranolol for treatment of infantile hemangiomas (IHs) was linked to higher rates of lesion clearance, fewer adverse effects, less surgical interventions after treatment, and lower cost compared with oral corticosteroids.
According to background information in the study, infantile hemangioma (IH), a common type of vascular tumor, tends to grow rapidly during the first three to 12 months of age, and then slowly and spontaneously regress from three to seven years of age.
The patient’s appearance may however not completely improve with regression of the IH tumor. If untreated, patients may develop ulcers, scarring, recurrent bleeding and impaired vision as well as hearing, feeding and defecation difficulties. In complicated cases, patients may develop heart problems, structural abnormalities, cosmetic disfigurement or psychosocial problems.
IHs therefore often require systemic, surgical and/or laser treatment to avoid these adverse effects. Most cases are treated with corticosteroids, with oral prednisolone the most common choice. Studies, since 2008, have suggested that propranolol (a beta blocker drug used for heart and circulatory problems) may also help treat IH.
Cynthia J. Price, M.D., formerly of the Miller School of Medicine, University of Miami, and her colleagues decided to examine the use of propranolol in IH patients without cardiac abnormalities, and to collate information about the optimal duration of treatment, associated adverse effects and relapses when treatment ends. They conducted a multicenter, retrospective review of 110 IH patients’ medical charts between February 2005 and October 2010.
Using photographs and clinical examination results, researchers split patients into two groups; patients’ whose IH was cleared by 75 percent or more (defined as a reduction of at least 75 percent in the tumor’s volume), and those whose tumor clearance was less than 75 percent.
The average propranolol treatment lasted for 7.9 months. Treatment with oral corticosteroids lasted 5.2 months. From a total of 68 patients who received propranolol, 56 (82 percent) displayed a tumor clearance of 75 percent or more in comparison to 12 (29 percent) of 42 patients who received oral corticosteroids. All 42 patients receiving corticosteroids showed adverse reactions compared to only three patients receiving propranolol. The propranolol group of patients relapsed after the end of the treatment, however, after another round of treatment an improvement was noticed. Further surgery was required by eight patients (12 percent) in the propranolol group, and 12 patients (29 percent) in the corticosteroid group. The overall average per-patient treatment costs were $205.32 and $416.00 in the propranolol and oral prednisolone groups, respectively.
In a concluding statement the authors write:
“Our study showed that propranolol therapy was more effective in lesion clearance, required fewer surgical referrals after treatment and demonstrated superior tolerance, with minimal adverse effects.” They continued to say, “Propranolol proved to be safe in treating IH in our patients as no major adverse effects occurred. Also, propranolol therapy was more cost-effective, with a cost reduction of more than 50 percent per patient.”
Written by Petra Rattue