Diagnosis and Management of Infantile Hemangioma

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Table 12. Resolution outcomes in studies comparing intralesional propranolol and triamcinolone Rebound Resolution Growth/ Age, Months Outcomes Recurrence Author, Year Comparison Groups (n) Quality Awadein et al. 2011 130 G1: Propranolol, intralesional 1mg/ml (12) G2: Triamcinolone, intralesional 40mg/ml(10) Quality: Poor Type Age, mean±SD G1: 5.9±2.7 G2: 6.1±2.9 Type NR Location G1+G2: Periocular Methods and Measures of Resolution/ Response • Size measured by clinical examination and photography • Response graded as: Excellentcomplete resolution achieved Goodsustained plateau with ≥ 50% reduction Fair-sustained plateau with < 50% reduction Poor-no response or worsening • Blinded assessment: NR Regression of IH G1:10/12 (83%) G2: 8/10 (80%) Response Excellent response G1:5/12 (42%) G2: 4/10 (40%) Good G1:3/12 (25%) G2: 2/10 (20%) Fair G1:2/12 (17%) G2: 2/10 (20%) Poor G1:2/12 (17%) G2: 2/10 (20%) Other Outcomes Rebound growth, n G1:4 G2: 3 Abbreviations: G = group; IH = infantile hemangioma; mg = milligram; ml = milliliter; n= number; NR = not reported; SD = standard deviation Vision outcomes • Significant reduction in astigmatic error in both the propranolol group (p=0.02) and the steroid group (p=0.03) but there was no between group differences (p=0.34, n=22) • No significant group difference in the degree of ptosis (p=0.46) Propranolol Plus Pulsed Dye Laser Versus Propranolol Alone A fair quality retrospective cohort study compared three treatments for facial segmental IH: concurrent propranolol and pulsed dye laser (n=12), propranolol followed by pulsed dye laser (n=5), and propranolol alone (n=8) (Table 13). 150 Mean hemangioma size was larger in the concurrent treatment group (41.65 cm 2 ) than the sequential (20.1 cm 2 ) and propranolol-only groups (18.0 cm 2 ). Among the 12 participants who received concurrent propranolol and pulsed dye laser, six (50%) had complete clearance and six (50%) had near-complete clearance. All five of the participants in the propranolol followed by pulsed dye laser group also had complete (n=2, 40%) or near-complete (n=3, 60%) clearance. Among the eight participants who receive propranolol alone, one (13%) had complete clearance, two (25%) near-complete clearance, and five (63%) partial clearance. The difference in effectiveness between combined therapy, either concurrently or sequentially, and propranolol alone was statistically significant. The number of days of propranolol treatment until near-complete clearance was significantly lower (p
Table 13. Resolution outcomes in studies comparing propranolol with laser and propranolol alone Author, Year Methods and Resolution Rebound Growth/ Age, Months Comparison Groups Measures of Outcomes Recurrence (n) Location Resolution/ Type Quality Response Other Outcomes Reddy et al. 2013 150 G1: Propranolol + pulsed dye laser concurrent (12) G2: Propranolol followed by pulsed dye laser (5) G3: Propranolol only (8) Quality: Fair Age, mean days G1: 43 G2: 62 G3: 47 Type, n (%) Superficial G1: 7 (58) G2: 0 G3: 3 (37.5) Compound G1: 5 (42) G2: 5 (100) G3:5 (62.5) G1+G2+G 3: Large or segmental - distribution facial G = group; IH = infantile hemangioma; NR = not reported • Photographs used to rate degree of clearance score by blinded physicians: 1: no improvement 2: partial improvement (significant residual superficial or deep IH) 3: nearcomplete clearance (mild residual superficial IH) 4: complete clearance (minimal to no residual superficial IH) Complete clearance G1: 6/12 (50) G2: 2/5 (40) G3: 1/8 (12.5) G1 vs.G2 vs.G3: p=0.01 Rebound growth NR Other outcomes • Significant difference between groups in the number of days of propranolol treatment until near-complete clearance of lesions, p
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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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Table 39. Strength of evidence for
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Table 39. Strength of evidence for
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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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20. Grundfest-Broniatowski S, Carey
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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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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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