Abstract
Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). Anecdotally, prescribing practice differs widely between centres. The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs. Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool. The study cohort comprised 1097 children from 39 centres in eight European countries. 76·1% were female and 92·8% had a focal IH, with the remainder showing a segmental, multifocal or indeterminate pattern. The main indications for treatment were periocular location (29·3%), risk of cosmetic disfigurement (21·1%) and ulceration and bleeding (20·6%). In total 69·2% of patients were titrated up to a maintenance regimen, which consisted of 2 mg kg(-1) per day (85·8%) in the majority of cases. 91·4% of patients had an excellent or good response to treatment. Rebound growth occurred in 14·1% upon stopping, of whom 53·9% were restarted and treatment response was recaptured in 91·6% of cases. While there was no significant difference in the treatment response, comparing a daily maintenance dose of < 2 mg kg(-1) vs. 2 mg kg(-1) vs. > 2 mg kg(-1) , the risk of adverse events was significantly higher: odds ratio (OR) 1 vs. adjusted OR 0·70, 95% confidence interval (CI) 0·33-1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04-5·46, P = 0·04, Ptrend < 0·001. The PITCH survey summarizes the use of oral propranolol across 39 European centres, in a variety of IH phases, and could be used to inform treatment guidelines and the design of an interventional study.
Highlights
Haemangiomas are the commonest benign tumour of infancy, with a postnatal incidence of around 5%.1 In the latest International Society for the Study of Vascular Anomalies classification, infantile haemangiomas (IHs) are morphologically subdivided into focal or localised, segmental, indeterminate and multifocal IHs.[2]
Oral propranolol is widely prescribed as first line treatment for infantile haemangiomas (IHs) and anecdotally prescribing practice differs widely between centres
The PITCH survey summarises the use of oral propranolol across 39 European centres, in a variety of IH phases and could be used to inform treatment guidelines and the design of an intervention study
Summary
Haemangiomas are the commonest benign tumour of infancy, with a postnatal incidence of around 5%.1 In the latest International Society for the Study of Vascular Anomalies classification, infantile haemangiomas (IHs) are morphologically subdivided into focal or localised, segmental, indeterminate and multifocal IHs.[2]. In addition to numerous case series and case reports, three randomised controlled trials have investigated the efficacy of propranolol in IHs, with the largest trial (n=456) comparing a dose of 3mg/kg/day with 1mg/kg/day dose and placebo, which found that the higher dose was significantly superior with regard to treatment efficacy.[5,6,7] this study only used propranolol for a maximum of 24 weeks, excluded patients outside the proliferation phase as well as children with life- or function-threatening or severely ulcerated IHs for ethical reasons, owing to the inclusion of a placebo group.[5] This would, for instance, have excluded segmental IH (SIHs). Oral propranolol is widely prescribed as first line treatment for infantile haemangiomas (IHs) and anecdotally prescribing practice differs widely between centres
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