Diagnosis and Management of Infantile Hemangioma

Table 36. Strength of evidence for effectiveness of beta-blockers
Outcome
Intervention
Oral propranolol
vs. Placebo or
Observation
Study Design
Quality and
Number of
Studies (N Total)
Improvement in IH
Network metaanalysis
RCT: 2 good, 17,92 1
fair 99 (510)
Cohort studies: 1
fair 94 (45)
Rebound
growth/Need for
additional
treatment
RCT: 1 good 92
(456)
Cohort studies: 1
fair 94 (45)
Study
Limitations
Consistency Directness Precision
Reporting
Bias
Finding
Strength of Evidence Grade
Low Consistent Indirect Precise Undetected In network meta-analysis, the mean
expected clearance rate for oral
propranolol was 95% (95% BCI: 88%
to 99%) relative to 6% (95% BCI: 1%
to 11%) for placebo/observation
arms; greater reductions in IH size in
propranolol arms vs. control in all
individual studies.
High SOE for greater effectiveness
of oral propranolol vs. placebo or
observation based on individual
comparisons and the network metaanalysis.
Low Consistent Direct Precise Undetected Fewer than 15% of children in
treatment arms had rebound growth
or required longer/additional
treatment.
Moderate SOE for low level of
rebound growth/need for further
treatment associated with
propranolol given few studies
addressing the outcome.
85