Propranolol in the treatment of infantile haemangiomas

Lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce Survey.

Dr Clayton was a co-author on this recently accepted manuscript written for the British Journal of Dermatology.

Abstract:

Background
Oral propranolol is widely prescribed as first line treatment for infantile haemangiomas (IHs) and anecdotally prescribing practice differs widely between centres.

Objectives
The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs.

Methods
Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool.

Results
The study cohort comprised 1096 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%). 69.2% of patients were titrated up to a maintenance regimen, which consisted of 2mg/kg/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 which 53.9% were restarted and treatment response was recaptured in 91.6% of cases. While there was no significant difference in the treatment reponse, comparing a maintenance dose of <2mg/kg/day versus 2mg/kg/day versus >2mg/kg/day, the risk of adverse events was significantly higher (OR=1 vs adjusted OR=0.70 (0.33-1.50), p=0.36 vs 2.38 (1.04-5.46), p=0.04, ptrend<0.001).

Conclusions
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.