Diagnosis and Management of Infantile Hemangioma

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Table C. Summary of evidence in studies addressing effectiveness of pharmacologic interventions (continued) Intervention Type/Number of Studies (Total N Participants) Key Outcome(s) Strength of Evidence (SOE) Grade Findings Beta-Blockers (continued) Oral propranolol vs. Placebo or Observation Network metaanalysis RCT: 3 (510) Improvement in IH High In network meta-analysis, the mean expected clearance rate for oral propranolol was 95% (95% BCI: 88%-99%) relative to 6% (95% BCI: 1%-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 propranolol vs. placebo or observation based on individual comparisons and the meta-analysis. Cohort studies: 1 (45) Propranolol vs. Placebo or Observation RCT: 1 (456) Cohort studies: 1 (45) Propranolol vs. Steroids Network metaanalysis RCT: 1 (19) Cohort studies: 4 (216) Propranolol vs. Steroids Cohort studies: 1 (43) Rebound growth/Need for further treatment Moderate 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. Improvement in IH Moderate In head-to-head comparisons, propranolol more effective than steroids in 3 studies; 2 other studies reported no significant difference between oral or intralesional propranolol and oral or intralesional steroids. In network meta-analysis, pooling data from multiple studies, propranolol was superior to oral steroids (95% [95% BCI: 88% to 99%] clearance versus 43% [ 95% BCI: 21% to 66%] clearance). Moderate SOE for superiority of propranolol over steroids at achieving clearance based on combined effects from individual studies and network meta-analysis, high study limitations, and inconsistency. Amblyopia Insufficient No significant difference in level of amblyopia between oral propranolol and intralesional triamcinolone arms in one small study. Insufficient SOE due to single study with high limitations. ES-20
Table C. Summary of evidence in studies addressing effectiveness of pharmacologic interventions (continued) Intervention Type/Number of Studies (Total N Participants) Key Outcome(s) Strength of Evidence (SOE) Grade Findings Beta-Blockers (continued) Oral propranolol + prednisolone vs. Prednisolone vs. Propranolol alone Improvement in IH Insufficient Significant size reductions from baseline in propranolol and combined arms (p values
Page 1 and 2: Comparative Effectiveness Review Nu
Page 3 and 4: This report is based on research co
Page 5 and 6: Acknowledgments The authors gratefu
Page 7 and 8: Peer Reviewers Prior to publication
Page 9 and 10: BCI; moderate SOE for effects of pr
Page 11 and 12: Overview of the Literature ........
Page 13 and 14: Executive Summary Introduction Infa
Page 15 and 16: for contextual questions as few eff
Page 17 and 18: Figure B. Analytic framework for KQ
Page 19 and 20: Table A. Inclusion criteria (contin
Page 21 and 22: precision (precise, imprecise), and
Page 23 and 24: Figure D. Estimates of expected IH
Page 25 and 26: majority of studies to date have in
Page 27 and 28: effectiveness outcomes. The evidenc
Page 29 and 30: changes. We considered the strength
Page 31: Table C. Summary of evidence in stu
Page 35 and 36: Table C. Summary of evidence in stu
Page 37 and 38: Table D. Summary of evidence in stu
Page 39 and 40: Applicability We set inclusion crit
Page 41 and 42: quantitative meta-analyses. Researc
Page 43 and 44: surgically. Lesion characteristics
Page 45 and 46: References 1. Wassef M, Blei F, Ada
Page 47 and 48: 39. Yu L, Li S, Su B, et al. Treatm
Page 49 and 50: modalities. The questions of imagin
Page 51 and 52: KQ2. Among newborns, infants, and c
Page 53 and 54: of data, and compiling evidence. We
Page 55 and 56: We only included studies published
Page 57 and 58: a standardized form (Appendix B) th
Page 59 and 60: Determining Quality Ratings • We
Page 61 and 62: Results We present results for Cont
Page 63 and 64: defects, urogenital anomalies, ulce
Page 65 and 66: Results of Literature Searches for
Page 67 and 68: Table 3. Characteristics of include
Page 69 and 70: scans, had a sensitivity of 20 perc
Page 71 and 72: of the model fit to all studies, bu
Page 73 and 74: Detailed Analysis Effectiveness of
Page 75 and 76: Table 6. Key resolution outcomes in
Page 77 and 78: with prednisolone included endocrin
Page 79 and 80: children in 8 studies), skin atroph
Page 81 and 82: hypopigmentation, impaired wound he
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fair quality for effectiveness outc
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studies of nadolol and atenolol. No
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Table 10. Key resolution outcomes i
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old. 100 Thirty percent of children
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Table 11. Resolution outcomes in st
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Table 15. Key outcomes in studies c
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Table 22. Harms/adverse effects in
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Table 24. Adverse effects in case s
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Table 24. Adverse effects in case s
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• In two RCTs reporting level of
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Nd:YAG Laser With Cooling Compared
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long term follow information was av
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Discussion State of the Literature
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Table 34. Strength of evidence for
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Effectiveness and Harms of Beta-Blo
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older children. One comparative stu
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case series reporting on rarer pres
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agents is critical, especially as u
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References 1. Wassef M, Blei F, Ada
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39. Chen TS, Eichenfield LF, Friedl
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80. Mai HM, Zheng JW, Wang YA, et a
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119. Sharma LK, Dalal SS. Corticost
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162. Snir M, Reich U, Siegel R, et
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198. Chen ZG, Zheng JW, Yuan ML, et
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237. Healy G, McGill T, Friedman EM
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Abbreviations and Acronyms Used in
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Appendix A. Search Strategies Searc
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Searches for Comparative Effectiven
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Appendix B. Screening and Quality A
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Harms Risk of Bias Assessment Form
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QUADAS Diagnostic Accuracy Rating T
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Infantile Hemangioma CER: Risk of B
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20. Grundfest-Broniatowski S, Carey
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65. Dachman AH, Lichtenstein JE, Fr
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111. Yoshida T, Kuratomi K, Mitsuma
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160. Newman SL, Goodwin CD. Colonic
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204. Crockett DM, Healy GB, McGill
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253. Wright GL, Smith RJ, Katz CD,
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301. Paley D, Jackson RW. Synovial
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346. Dombrowski MP, Budev H, Wolfe
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390. Stringel G. Giant hemangioma:
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2327. Czernik A, Bystryn JC. Does i
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2995. Storch CH, Hoeger PH. Propran
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3243. Soltani AM, Reinisch JF. Algo
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3286. . Derm Dx. Clinical Advisor.
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3407. Kupeli S. Use of propranolol
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where ΦΦ(xx) is the cumulative di
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Figure D-1. Estimates of expected I
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Figure D-3. Posterior SUCRA estimat
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Figure D-5. Network diagram of comp
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Appendix E. Study Design Classifica
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Author, Year Hogeling 2011 10 Alloc
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Author, Year Representativeness of
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Author, Year Were the harms predefi
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25. Qiu Y, Ma G, Yang J, et al. Imi
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56. Hassan BA, Shreef KS. Propranol
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88. Chakkittakandiyil A, Phillips R
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120. Pandey A, Gangopadhyay AN, Gop
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Appendix G. Applicability Tables Ta
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Appendix H. Harms Reported in Packa
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o Acquired (autoimmune) hemolytic a
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o Ankylosing spondylitis o Dermatom
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H-7 • Increased dosage of rapidly
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Elocon® (mometason e furoate) 11 T
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Timoptic® (timolol maleate) 15 Tim
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Harms Data for Medications Included
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Table H-3: Adverse Events from Flo-
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(
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thromboembolism, thrombophlebitis,
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grades): 103 (48%), erosion/ulcerat
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acute myocardial infarction: 3 (Rat
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Discontinuations Patients utilizing
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ocular irritation including blephar
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Diagnosis and Management of Infantile Hemangioma

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