Beta-Blocker Effective in Infantile Hemangiomas
The beta-blocker propranolol is an effective treatment for head and neck infantile hemangiomas, researchers reported.
In a multi-institutional retrospective study, the compound lightened and reduced hemangiomas in 37 of 39 children, according to Carine Fuchsmann, MD, from Hospices Civils de Lyon in Bron, France, and colleagues.
Recurrences were rare and when they occurred propranolol was again effective, Fuchsmann and colleagues reported in the May issue of Archives of Otolaryngology -- Head & Neck Surgery.
The finding is additional evidence that the drug is effective, especially when it is started within the early growth phases of the hemangioma, Fuchsmann and colleagues argued.
The effect of the drug was discovered by accident, when two French researchers used it to treat children with cardiopulmonary conditions as well as hemangiomas.
Unexpectedly, the skin lesions began to fade, prompting other clinicians to try propranolol instead of corticosteroids, which had been the previous standard treatment, Fuchsmann and colleagues noted.
To try to quantify the effects, the researchers examined medical records of 39 children treated with the drug between Jan. 10, 2008, and Sept. 30, 2009, at two tertiary care referral pediatric centers, one in France and one in Canada.
In 60% of patients, propranolol (at two to three milligrams per kilogram per day ) was the only therapy, they reported, and was started at an early age (4.1 months on average) in 33 of the 39 children.
Sixteen of the children had undergone previous treatment that was ineffective or could not be stopped without relapse, the researchers reported, including nine who had intralesional injection of corticosteroids.
Eight of the children had airway lesions that were either life threatening or causing respiratory difficulties and failure to thrive, they reported, and 13 had hemangiomas with a risk of future functional complications.
The treatment with propranolol, on the other hand, was effective in most of the children -- 37 of the 39 -- with improvements beginning between two days and two weeks, the researchers reported.
Two children -- one with a subglottic hemangioma and one with a nasal tip lesion -- did not respond or showed only a partial response, Fuchsmann and colleagues reported, but in both cases, the treatment had been started after several months of growth, at ages 13 and 14 months, respectively.
Twenty-six of the successfully treated lesions were in locations -- the nose, lips, and parotid area -- for which long-term corticosteroid treatment would not have been initiated, unless there had been ulceration or bleeding, the researchers noted.
Among the 33 youngest patients, propranolol therapy was stopped in 25 at ages ranging from 7 to 17 months, after an average treatment duration of 8.5 months.
All told, 21 children had no relapse after the treatment was stopped, while nine had some mild regrowth or coloration, the researchers reported. Treatment is continuing in another nine children.
Even for the older children -- ages 11 to 56 months -- the treatment was effective in four of the six patients, the researchers reported.
Five children were switched to acebutolol (Sectral, Prent) because of sleeping difficulties attributed to the propranolol, but there were no treatment changes owing to complications.
The researchers cautioned that the optimal dosing and the age at which treatment should stop remain open questions that should be addressed by prospective studies.
Source: medpagetoday
