Diagnosis and Management of Infantile Hemangioma

Table 36. Strength of evidence for effectiveness of beta-blockers (continued)
Outcome
Intervention
Oral propranolol
vs. Other betablocker
Oral propranolol
vs. Intralesional
bleomycin
Topical timolol vs.
Placebo or
Observation
Study Design
Quality and
Number of
Studies (N Total)
Improvement in IH
RCT: 1 fair 102 (23)
Cohort studies: 1
fair, 1 poor 101,146-148
(77)
Improvement in IH
Cohort studies: 1
poor 95 (20)
Improvement in IH
Network metaanalysis
RCT: 1 good 104 (41)
Cohort studies: 1
fair, 1 poor 103,144
(147)
Study
Limitations
Consistency Directness Precision
Reporting
Bias
Finding
Strength of Evidence Grade
High Consistent Indirect Imprecise Undetected In head-to-head comparisons, no
significant differences in response
between propranolol and atenolol in
2 studies; better response to nadolol
vs. propranolol in one small study.
Low SOE for no difference in
response with propranolol, nadolol,
or atenolol (systemic beta-blockers)
based on few, small studies.
High Unknown Direct Imprecise NA No difference between agents in one
small study.
Insufficient SOE due to single study
with high limitations.
Medium Consistent Indirect Precise Undetected Timolol more effective than placebo
or observation in three comparative
studies.
In network meta-analysis, the mean
expected clearance rate for topical
timolol was 62% (95% BCI: 39% to
83%) relative to 6% (95% BCI: 1% to
11%) for placebo or observation
arms.
Low SOE for effectiveness of timolol
vs. placebo or observation based on
medium study limitations and few
studies.
87