Propranolol in the Treatment of Infantile Haemangiomas

Wedge­worth et al, The British Jour­nal of Der­ma­tol­ogy. 2016

Abstract

Back­ground Oral pro­pra­nolol is wide­ly pre­scribed as first-line treat­ment for infan­tile hae­man­giomas (IHs). Anec­do­tal­ly, pre­scrib­ing prac­tice dif­fers wide­ly between cen­tres.

Objec­tives The Pro­pra­nolol In the Treat­ment of Com­pli­cat­ed Hae­man­giomas (PITCH) Task­force was found­ed to estab­lish pat­terns of use of pro­pra­nolol in IHs.

Results The study cohort com­prised 1097 chil­dren from 39 cen­tres in eight Euro­pean coun­tries. 76·1% were female and 92·8% had a focal IH, with the remain­der show­ing a seg­men­tal, mul­ti­fo­cal or inde­ter­mi­nate pat­tern. The main indi­ca­tions for treat­ment were peri­oc­u­lar loca­tion (29·3%), risk of cos­met­ic dis­fig­ure­ment (21·1%) and ulcer­a­tion and bleed­ing (20·6%). In total 69·2% of patients were titrat­ed up to a main­te­nance reg­i­men, which con­sist­ed of 2 mg kg−1 per day (85·8%) in the major­i­ty of cas­es. 91·4% of patients had an excel­lent or good response to treat­ment. Rebound growth occurred in 14·1% upon stop­ping, of whom 53·9% were restart­ed and treat­ment response was recap­tured in 91·6% of cas­es. While there was no sig­nif­i­cant dif­fer­ence in the treat­ment response, com­par­ing a dai­ly main­te­nance dose of < 2 mg kg−1 vs. 2 mg kg−1 vs. > 2 mg kg−1, the risk of adverse events was sig­nif­i­cant­ly high­er: odds ratio (OR) 1 vs. adjust­ed OR 0·70, 95% con­fi­dence inter­val (CI) 0·33–1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04–5·46, P = 0·04, P trend < 0·001.

Con­clu­sions The PITCH sur­vey sum­ma­rizes the use of oral pro­pra­nolol across 39 Euro­pean cen­tres, in a vari­ety of IH phas­es, and could be used to inform treat­ment guide­lines and the design of an inter­ven­tion­al study.