Diagnosis and Management of Infantile Hemangioma

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Model Results The expected efficacy of control arms was estimated to be 0.06 (95% Bayesian credible interval = [0.01, 0.11]). All non-control treatments were estimated to have a larger expected clearance than control (Figure D-1). The largest mean estimate was oral propranolol (0.95, 95% BCI = [0.88, 0.99]), followed by timolol (0.62, 95% BCI = [0.39, 0.83]) and triamcinolone (0.58, 95% BCI = [0.22, 0.93]). Oral steroids had a mean clearance estimate of 0.43(95% BCI = [0.21, 0.66]). We calculated the probability that each of the non-control interventions is the best treatment, based on expected clearance rate. This was estimated from the MCMC simulation that tallied the number of iterations that each intervention had the highest expected value, and calculating the proportion for each intervention as an estimate of the probability of being best. Oral propranolol had the highest probability (99%), followed by triamcinolone (1%); all others had probabilities less than 1% combined. To better account for the uncertainty in the estimated treatment effects, we also calculated the surface under the cumulative ranking curve (SUCRA) for each treatment, which provides a probabilistic summary of the rankings of the treatments (Figure D-3). Oral propranolol had the highest SUCRA score (0.902), intralesional propanolol the lowest (0.119), with the other treatments intermediate. Propanolol was estimated to have the largest variability in clearance rate (Figure D-2, σ=2.5, 95% BCI = [2.1, 2.9]) with timolol (σ=1.5, 95% BCI: 1.4 to 1.6), intralesional triamcinolone (σ=1.8, 95% BCI: 1.3 to 2.3), and oral steroids (σ=1.3, 95% BCI: 1.1 to 1.6) yielding similar, lower estimates. With the exception of Timolol, interventions with larger effect sizes tended to have larger effect size variance. Table D-1. Posterior estimates of effect size Mean SE 95% Credible interval Oral propranolol 6.0 0.7 [4.6 7.5] Timolol 3.5 0.5 [2.4 4.6] Triamcinolone 3.3 0.8 [1.7 4.9] Oral steroid 2.6 0.5 [1.8 3.6] Note: Posterior estimates of effect size, on logit scale, relative to control, along with standard error and 95% credible interval. Positive values indicate increased clearance relative to control, negative indicate decreased clearance. D-3
Figure D-1. Estimates of expected IH clearance Note: Estimates of expected IH clearance (expressed as percent clearance relative to initial condition) for each treatment, along with associated posterior interquartile range (thick lines) and 95% credible interval (thin lines). D-4
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Comparative Effectiveness Review Nu
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This report is based on research co
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Acknowledgments The authors gratefu
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Peer Reviewers Prior to publication
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BCI; moderate SOE for effects of pr
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Overview of the Literature ........
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Executive Summary Introduction Infa
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for contextual questions as few eff
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Figure B. Analytic framework for KQ
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Table A. Inclusion criteria (contin
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precision (precise, imprecise), and
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Figure D. Estimates of expected IH
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majority of studies to date have in
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effectiveness outcomes. The evidenc
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changes. We considered the strength
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Table C. Summary of evidence in stu
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Table D. Summary of evidence in stu
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Applicability We set inclusion crit
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quantitative meta-analyses. Researc
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surgically. Lesion characteristics
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References 1. Wassef M, Blei F, Ada
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39. Yu L, Li S, Su B, et al. Treatm
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modalities. The questions of imagin
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KQ2. Among newborns, infants, and c
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of data, and compiling evidence. We
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We only included studies published
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a standardized form (Appendix B) th
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Determining Quality Ratings • We
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Results We present results for Cont
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defects, urogenital anomalies, ulce
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Results of Literature Searches for
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Table 3. Characteristics of include
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scans, had a sensitivity of 20 perc
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of the model fit to all studies, bu
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Detailed Analysis Effectiveness of
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Table 6. Key resolution outcomes in
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with prednisolone included endocrin
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children in 8 studies), skin atroph
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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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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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Page 371: where ΦΦ(xx) is the cumulative di
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Page 403 and 404: 120. Pandey A, Gangopadhyay AN, Gop
Page 405 and 406: Appendix G. Applicability Tables Ta
Page 407 and 408: Appendix H. Harms Reported in Packa
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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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