Rebound Growth of Infantile Hemangiomas after Propranolol versus Atenolol Treatment: A Retrospective Study

Propranolol is the first-line treatment for complicated infantile hemangioma (IH). Rebound growth following propranolol discontinuation is reported in 6-25% of patients. Atenolol is considered an effective alternative to propranolol. We aimed to compare the incidence of IH rebound growth following discontinuation of atenolol and propranolol and to identify associated risk factors.

We reviewed the medical records of all the patients diagnosed with IH and treated with oral propranolol or atenolol during 2009-2019 in our tertiary center. Inclusion criteria were completion of at least 3 months of initial treatment and at least 3 months of follow-up after discontinuation of initial treatment.

Of 445 patients in total, 267 (60%) were treated with propranolol and 178 (40%) with atenolol. The incidence of rebound growth was similar between the groups: 59 (22.1%) and 40 (22.5%), respectively. Patients treated with atenolol required a shorter duration of treatment after rebound growth until growth arrest (9.41 ± 5.61 vs. 14.79 ± 10.02 months, p < 0.001). For the patients who initiated atenolol before the age of 5 months, the adjusted odds ratio (aOR) for regrowth was 0.6 (95% CI: 0.33-1.08). As duration of treatment increased, the risk of rebound growth increased; the aOR was 1.24 (95% CI: 1.10-1.38). No other significant risk factors for rebound growth were identified.

The incidence of rebound growth was similar following treatment with two oral β-receptor blockers. Treatment initiation after the age of 5 months and long duration of treatment may increase the risk for regrowth. These findings should be further investigated as they may impact clinical decisions on treating IH.