Extended propranolol use increases treatment success in high-risk infantile hemangioma
Continuing treatment with oral propranolol beyond 6 months and up to 12 months appears to be effective in most patients with high-risk infantile hemangioma (IH), producing meaningful increases in treatment success, a study has shown.
The single-arm, open-label, phase III study included 43 infants aged 35–150 days with high-risk IH, who were initially treated with oral propranolol at 3 mg/kg per day for 6 months (initial treatment period [ITP]). If complete success was not achieved by 6 months, patients were retreated for up to 12 months of age (continuation period). Those who achieved success in the ITP were managed for 3 months without treatment (follow-up period). If rebound growth occurred during the follow-up period, treatment was reinitiated until success for 6 months maximum.
The primary outcome of treatment success after ITP was 47 percent. This number increased to 76 percent up to 12 months of age. Of the patients successfully treated, 68 percent sustained success for 3 months without treatment, with 24 percent requiring retreatment. Treatment success during the retreatment phase was documented in seven of eight patients.
Adverse events, which occurred in 80 percent of patients, were mild and consistent with known propranolol side effects.
The present data show that continuing propranolol treatment for up to 12 months of age effectively increases success rate in high-risk IH, with a satisfactory safety profile, researchers said.
To date, there is no consensus on the optimal duration of treatment with propranolol, which is used in the first-line setting, for IH. However, treatment up to 12 months of age has been proposed for those who do not fully respond to a 6-month course. [Sci Rep 2017;7:43292; J Plast Reconstr Aesthet Surg 2011;64:292-299; J Pediatr Surg 2012;47:707-714]