Diagnosis and Management of Infantile Hemangioma

Table C. Summary of evidence in studies addressing effectiveness of pharmacologic interventions
Intervention
Type/Number of
Studies (Total N
Participants)
Key Outcome(s)
Strength of
Evidence
(SOE) Grade
Steroids
Oral steroids vs.
Observation or
Placebo
Findings
Improvement in IH Moderate In network meta-analysis oral steroids had a mean expected clearance
rate of 43% (95% BCI: 21%-66%) compared with 6% (95% BCI: 1%-
11%) for placebo/observation arms.
Network metaanalysis
Intralesional Steroids
vs. Observation or
Placebo
Moderate SOE for greater effectiveness of oral steroids vs.
placebo/observation given low precision and high study limitations.
Improvement in IH Low In network meta-analysis intralesional steroids had a mean expected
clearance rate of 58% (95% BCI: 22%-93%) compared with 6% (95%
BCI: 1%-11%) for placebo/observation arms.
Network metaanalysis
All steroids
RCT: 3 (138)
Cohort studies: 3
(179)
Case series: 10
(2974)
Clinically important
harms (Cushingoid
facies, growth
retardation, mood
changes /irritability,
hypertension,
infection)
Moderate
Low SOE for greater effectiveness of intralesional steroids vs.
placebo/observation given relatively small numbers of participants
contributing to this comparison and low precision.
Comparative studies, case series, and package insert data consistently
reported these adverse effects.
Moderate SOE for association of steroids with clinically important harms
due to high study limitations.
ES-19