Figuring Out the Duration of Propranolol Use in Infantile Hemangiomas
LewisFirst, MD, MS, Editor in Chief, Pediatrics
There is no doubt that propranolol is a first line treatment for infantile hemangiomas.
What we aren’t as sure of is just how long to treat babies with these vascular malformations—that
is until Baselga et al. (10.1542/peds.2017-3866) opted to study what an effective and safe duration of treatment might be. The authors
looked at results when propranolol was used for a minimum of 6 months to a maximum
of 12 months in a single –arm, open-label phase 3 study in infants who had high-risk
infantile hemangiomas in the proliferative phase. The infants were given oral propranolol
twice a day at a total dose of 3mg/kg/day with the endpoint being success rate—i.e.
disappearance of the hemangioma. The success rate ranged from 47% to 76% and of those
who did achieve success, that success remained without need for treatment for 3 months
and only 24 % required a retreatment. The safety profile for this treatment seems
acceptable. While 80% of patients reported adverse events, all were known for the
drug. While one year of treatment may seem excessive, this study suggests otherwise
and does far more than just skin the surface when it comes to adding to the literature
on why propranolol is first line treatment for 6-12 months for infantile hemangiomas.