Diagnosis and Management of Infantile Hemangioma

Table 14. Resolution outcomes in studies comparing propranolol and bleomycin
Author, Year
Comparison Groups
(n)
Quality
Thayal et al. 2012 95
G1: Propranolol, oral 2
mg/kg/day (10)
G2: Bleomycin,
intralesional 0.5 mg/kg
(10)
Quality: Poor
Age, Months
Age
NR
Type
Type, %
Cutaneous:
G1+G2:100
Location
NR
Methods and
Measures of
Resolution/
Response
• Regression in
size of lesion 5
grades:
I Complete
involution (>
90% response)
II Reduction in
size 75-90%
III Reduction
50-75%
IV Reduction
25-50%
V Reduction <
25%
• Blinded
assessment:
NR
G = group; kg = kilogram; mg = milligram; n = number; NR = not reported
Resolution
Outcomes
Response, n
Grade I response
G1: 2
G2: 1
Grade II response
G1: 4
G2: 5
Grade III response
G1: 3
G2: 2
Grade IV
response
G1: 1
G2: NR
Rebound
Growth/
Recurrence
NR
Other
Outcomes
Propranolol Versus No Propranolol
A fair quality retrospective cohort study examined the effect of propranolol on the incidence
of invasive procedures in 58 children with nasal IH. 149 Participants fell into three groups: treated
in the pre-propranolol era (n=20), treated in the post-propranolol era and received propranolol
(n=25), and treated in the post-propranolol era and did not receive propranolol (n=13). Many
participants received other therapies including corticosteroids, laser treatments, and/or surgery.
Participants who received propranolol had a lower likelihood of laser treatment than those
treated in the pre-propranolol era (hazard ratio 0.44, 95% CI: 0.27 to 0.78). The risks of surgical
excision did not differ significantly (hazard ratio 0.45, 95% CI: 0.15 to1.38).
Another fair quality cohort study conducted in the Netherlands compared 20 children
with ulcerated IH treated with propranolol with 20 historical controls (matched on age at IH
onset, extent of ulceration, and type, location and size of the IH). 145 Children in the control group
had received steroids (25%), PDL (1%), antibiotics (60%), and local wound care (100%). Mean
age of the patients at the start of ulceration was 2.3 months, and complete healing occurred after
an average total ulceration time of 8.7 weeks in the propranolol treated group versus 22.4 weeks
(p= 0.012) in the historical control group. Four of 19 (20%) patients who completed propranolol
treatment had regrowth. One (0.5%) patient restarted propranolol due to significant regrowth of
the IH, affecting surrounding structures. Table 15 outlines key outcomes.
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