Retrospective analysis of beta-blocker instituted for treatment of hemangiomas (RABBIT study)
Derek H Chu1, Leslie Castelo-Soccio2, Joy Wan3
1Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA derek.chu@uphs.upenn.edu.
Insights
Our study found that propranolol is a safe and effective treatment for infantile hemangiomas (IH), with only minor side effects observed. However, hemangioma regrowth can occur after stopping propranolol treatment.
Area of Science:
- Pediatric dermatology
- Vascular anomalies
Background:
- Infantile hemangiomas (IH) are common benign vascular tumors in infants.
- Complicated IH can lead to functional deficits, disfigurement, and systemic complications.
- Beta-blockers, particularly propranolol, have emerged as a primary treatment modality for IH.
Purpose of the Study:
- To evaluate the safety and efficacy of an institutional beta-blocker protocol for treating complicated infantile hemangiomas (IH).
Main Methods:
- A retrospective descriptive study of 76 infants and children with IH treated with oral propranolol.
- Data on safety and efficacy were collected between June 2008 and August 2010.
- An additional 9 patients with hemangioma recrudescence off-treatment were reviewed.
Main Results:
- Propranolol treatment was associated with mild adverse events, including asymptomatic bradycardia, gastrointestinal symptoms, and sleep disturbances.
- Sixteen patients experienced IH recrudescence after discontinuing propranolol, with a median discontinuation age of 14 months.
- No severe symptomatic adverse events were reported.
Conclusions:
- Propranolol is a safe and effective treatment for complicated infantile hemangiomas.
- Adverse events associated with propranolol are generally mild and transient.
- Hemangioma recrudescence can occur after treatment cessation, even when propranolol is discontinued later in infancy.
Objective:
To evaluate the safety and efficacy of our institutional beta-blocker protocol for treatment of complicated infantile hemangiomas (IH).
Study Design:
A retrospective descriptive study of 76 infants/children with IH treated with oral propranolol at the Children's Hospital of Philadelphia between June 2008 and August 2010 was performed, assessing both the safety and efficacy of propranolol. Based on preliminary data showing hemangioma recrudescence off-treatment, we reviewed 9 additional patients with recrudescence between August 2010 and December 2011.
Results:
Mild adverse events included asymptomatic bradycardia, gastrointestinal symptoms, asymptomatic hypotension, cool hands/feet, asymptomatic hypoglycemia, and sleep disturbance. Sixteen patients had recrudescence of IH off-treatment, with propranolol discontinued at a median age of 14 months (interquartile range 10-15 months).
Conclusions:
Propranolol appears to be associated with minor, not severe symptomatic adverse events. Propranolol appears to be effective in treating complicated IH. Recrudescence can occur off-treatment, even with discontinuing propranolol as late as 15 months of age.
Related Concept Videos
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:22Heart Failure Drugs: β-Blockers
01:25Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers
01:28Antihypertensive Drugs: Types of β-Blockers
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...