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Effectiveness of Propranolol in Preventing Severe Retinopathy of Prematurity: A Comprehensive Systematic Review and
Muhammad Ashir Shafique1, Abdul Haseeb1, Muhammad Musab Nafees Uddin1
1From the Jinnah Sindh Medical University (M.A.S., A.H., M.M.N.U., B.A., E.R.C., M.S.M.), Karachi, Sindh, Pakistan.
Insights
Oral propranolol effectively prevents severe retinopathy of prematurity (ROP) in preterm newborns. This beta-blocker offers a promising therapeutic alternative for ROP prevention, reducing the need for further interventions.
Area of Science:
- Neonatal medicine
- Ophthalmology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of preventable blindness in premature infants.
- Current therapeutic options for ROP have limitations and associated risks.
Purpose of the Study:
- To evaluate the effectiveness of oral propranolol for preventing severe ROP in preterm newborns.
- To assess propranolol as a therapeutic alternative and early preventive measure for ROP.
Main Methods:
- Systematic review and meta-analysis of published literature up to May 10, 2023, adhering to PRISMA guidelines.
- Inclusion of trials and observational studies using beta-blockers to prevent severe ROP (stage ≥3 or requiring treatment).
- Analysis of 8 selected studies out of 3646 initially identified papers.
Main Results:
- Oral propranolol use was associated with a significantly lower risk of developing ROP (RR = 0.59, P = .002).
- Propranolol reduced the risk of plus disease (RR = 0.42, P = .006), need for laser photocoagulation (RR = 0.48, P = .001), and intravitreal VEGF injections (RR = 0.43, P = 0.003).
- No statistically significant heterogeneity was found across the included studies (P > .10, I² = 50%).
Conclusions:
- Oral propranolol is an effective preventive treatment for severe ROP in premature infants.
- Further consideration of propranolol dosage and timing is crucial for optimizing treatment outcomes in specific patient populations.
Purpose:
To learn more about the effectiveness of oral propranolol as a therapeutic alternative for preterm newborns with pre-existing retinopathy of prematurity (ROP) as well as an early prevention method for ROP, one of the most common but avoidable causes of juvenile blindness.
Study Design:
Meta-analysis of relevant literature.
Methods:
A total of 3464 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, finally, a total of 8 studies were deemed suitable for review. Following the PRISMA guidelines, published literature was systematically assessed up to May 10, 2023. Trials and observational studies were included in which beta blockage was used to prevent severe ROP (defined as stage ≥3 or requiring treatment). A total of 3646 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, a total of 8 studies were deemed suitable for review.
Results:
The use of propranolol is linked to a lower risk of disease development in ROP compared to other therapies or control groups, according to the overall risk ratio of 0.59 (95% CI = 0.42, 0.82; P = .002, I2 = 41%). Additionally, the overall risk ratio for plus disease is 0.42 (95% CI = 0.23, 0.78; P = .006, I2 = 0%), for laser photocoagulation is 0.48 (95% CI = 0.31, 0.74; P = .001; I2 = 2%), and for intravitreal injection of VEGF is 0.43 (95% CI = 0.24, 0.74; P = 0.003, I2 = 0%), suggesting that use of propranolol may reduce the likelihood of developing a disease such as plus disease, requiring laser photocoagulation or necessitating intravitreal injection of vascular endothelial growth factor for ROP, respectively. No statistically significant heterogeneity was found in this study (P > .10, I2 = 50%). It can be concluded from this that the results of the chosen studies were sufficiently comparable and consistent.
Conclusion:
This study showed that oral propranolol given as a preventive treatment in premature newborns successfully prevented severe ROP. Propranolol dosage and timing must now be carefully considered in the context of the study population, as these factors may have a major impact on the observed outcomes and treatment success.
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