Comparison of the efficacy and safety of lasers, topical timolol, and combination therapy for the treatment of infantile hemangioma: A meta-analysis of 10 studies.

Abstract

Topical timolol and lasers are widely used for the treatment of infantile hemangioma (IH), and they can replace propranolol as the first-line treatment of IH. We aimed to investigate the efficacy and safety of topical timolol alone or lasers plus topical timolol versus lasers alone for the treatment of IH using a meta-analysis. We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. A more conservative random effect model meta-analysis technique was used to analyze the efficacy and adverse reactions of timolol and lasers. Ten RCTs with a total of 979 patients with IH were included in this meta-analysis. Treatment with topical timolol alone was as effective as lasers in treating IH (risk ratio [RR]=0.99, p= 0.94), with similar adverse events. The difference was not statistically significant (RR=1.67, p= 0.14). Combined treatment with topical timolol and lasers showed a favorable response rate compared with treatment with either lasers (RR=1.23, p= 0.01) or topical timolol (RR=1.35, p= 0.001) alone. Furthermore, compared to topical timolol alone, the combined treatment indicated similar risks of adverse events (RR=0.70, p= 0.38) but fewer risks of adverse events (RR=0.39, p= 0.004) compared to lasers alone. This meta-analysis provided evidences that a combined treatment with topical timolol and lasers might be more effective than a single treatment strategy in infants with IH, and with no significant increase in adverse reactions. The combination of topical timolol and laser therapy might be the preferred choice for the treatment of IHs.