Exploration of the optimal time to discontinue propranolol treatment in infantile hemangiomas: A prospective study

Abstract

BackgroundRelapse of infantile hemangiomas (IHs) after withdrawal from propranolol treatment is common. Early withdrawal is believed to increase the risk of relapse. ObjectiveTo determine the optimal time to discontinue propranolol treatment for IHs. MethodsA prospective study conducted at a tertiary referral center. ResultsCompared to withdrawal after 1-month maintenance treatment, withdrawal after 3-months maintenance, corresponding achieving maximum regression of IHs, was associated with a lower major relapse rate (P=0.041). The relapse (P=0.055) and adverse event rates (P=0.154) between the two withdrawal modes were not statistically significant. Compared with direct withdrawal, the relapse (P=0.396), major relapse (P=0.963), and adverse event rates (P=0.458) of gradual withdrawal were not statistically different. Patients with/without relapse could be best distinguished according to whether withdrawal followed a 3-months maintenance and age >13 months (AUC=0.603). Patients with/without major relapse could be best distinguished according to whether withdrawal was accompanied by 3-months maintenance (AUC=0.610). LimitationsNon-randomization and single-center design. ConclusionsThe optimal propranolol withdrawal time to avoid relapse is when the patient is aged >13 months and the lesion has maintained for 3 months after reaching maximum regression, while the optimal time to prevent major relapse is after 3 months of maintenance.