Local administration of β-blockers for infantile hemangiomas

A systematic review and meta-analysis

Steven A. Ovadia, David C. Landy, Erin R. Cohen, Ethan Y. Yang, Seth Thaller

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Infantile hemangiomas (IHs) are a common pediatric lesion. Orally administered β-blockers have been reported as effective in treating these lesions. However, oral administration is also associated with systemic adverse effects. Treatment with locally administered β-blockers may provide acceptable efficacy with lower incidence of adverse effects. This may offer a better firstline treatment. Methods: PubMed was searched through March 2014 for studies reporting patient-level response of 5 or more patients treated with intralesional propranolol, topical timolol, or topical propranolol for cutaneous IHs. Rates of response to treatment, defined as clinically significant regression, were combined using random-effects meta-analysis. Results: Ninety-four articles were identified. Seventeen articles met the study criteria. These studies primarily focused on superficial IHs. Response rates for topical propranolol and topical timolol were not significantly different, 76% [95% confidence interval (CI), 62%-86%] and 83% (95% CI, 65%-93%), respectively (P = 0.45). Prospectively conducted studies reported lower response rates compared to retrospective studies for both topical propranolol (P = 0.06) and topical timolol (P < 0.01). When only prospectively conducted studies were included, response rates for topical propranolol and topical timolol were not significantly different, 72% (95% CI, 57%-83%) and 72% (95% CI, 53%-86%), respectively (P = 0.98). Significant adverse effects were rare. Only 1 case of sleep disturbance was reported across 554 patients from all studies. Conclusions: Topically administered β-blockers are an effective treatment for superficial IHs that pose few adverse effects and should be considered for primary treatment.

Original languageEnglish (US)
Pages (from-to)256-262
Number of pages7
JournalAnnals of Plastic Surgery
Volume74
Issue number2
DOIs
StatePublished - 2015

Fingerprint

Hemangioma
Timolol
Propranolol
Meta-Analysis
Confidence Intervals
Therapeutics
PubMed
Oral Administration
Sleep
Retrospective Studies
Pediatrics
Skin
Incidence

Keywords

  • Infantile hemangioma
  • Meta-analysis
  • Propranolol
  • Systematic review
  • Topical
  • β-Blockers

ASJC Scopus subject areas

  • Surgery

Cite this

Local administration of β-blockers for infantile hemangiomas : A systematic review and meta-analysis. / Ovadia, Steven A.; Landy, David C.; Cohen, Erin R.; Yang, Ethan Y.; Thaller, Seth.

In: Annals of Plastic Surgery, Vol. 74, No. 2, 2015, p. 256-262.

Research output: Contribution to journalArticle

Ovadia, Steven A. ; Landy, David C. ; Cohen, Erin R. ; Yang, Ethan Y. ; Thaller, Seth. / Local administration of β-blockers for infantile hemangiomas : A systematic review and meta-analysis. In: Annals of Plastic Surgery. 2015 ; Vol. 74, No. 2. pp. 256-262.
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abstract = "Background: Infantile hemangiomas (IHs) are a common pediatric lesion. Orally administered β-blockers have been reported as effective in treating these lesions. However, oral administration is also associated with systemic adverse effects. Treatment with locally administered β-blockers may provide acceptable efficacy with lower incidence of adverse effects. This may offer a better firstline treatment. Methods: PubMed was searched through March 2014 for studies reporting patient-level response of 5 or more patients treated with intralesional propranolol, topical timolol, or topical propranolol for cutaneous IHs. Rates of response to treatment, defined as clinically significant regression, were combined using random-effects meta-analysis. Results: Ninety-four articles were identified. Seventeen articles met the study criteria. These studies primarily focused on superficial IHs. Response rates for topical propranolol and topical timolol were not significantly different, 76{\%} [95{\%} confidence interval (CI), 62{\%}-86{\%}] and 83{\%} (95{\%} CI, 65{\%}-93{\%}), respectively (P = 0.45). Prospectively conducted studies reported lower response rates compared to retrospective studies for both topical propranolol (P = 0.06) and topical timolol (P < 0.01). When only prospectively conducted studies were included, response rates for topical propranolol and topical timolol were not significantly different, 72{\%} (95{\%} CI, 57{\%}-83{\%}) and 72{\%} (95{\%} CI, 53{\%}-86{\%}), respectively (P = 0.98). Significant adverse effects were rare. Only 1 case of sleep disturbance was reported across 554 patients from all studies. Conclusions: Topically administered β-blockers are an effective treatment for superficial IHs that pose few adverse effects and should be considered for primary treatment.",
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