Propranolol in the treatment of infantile haemangiomas

lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey

E Wedgeworth, M Glover, A D Irvine, I Neri, E Baselga, T H Clayton, P E Beattie, J V Bjerre, N P Burrows, R Foelster-Holst, L Hedelund, A Hernandez-Martin, H Audrain, K Bhate, S J Brown, S Baryschpolec, S Darne, A Durack, V Dvorakova, J Gach & 35 others N Goldstraw, H Goodyear, S Grabczynska, D Greenblatt, J Halpern, R M R Hearn, S Hoey, B Hughes, R Jayaraj, E K Johansson, M Lam, S Leech, G M O'Regan, D Morrison, W Porter, R Ramesh, T Schill, L Shaw, A E M Taylor, R Taylor, J Thomson, P Tiffin, M Tsakok, S R Janmohamed, B Laguda, T McPherson, A P Oranje, A Patrizi, J C Ravenscroft, H Shahidullah, L Solman, A Svensson, C F Wahlgren, P H Hoeger, C Flohr

    Research output: Contribution to journalArticle

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    Abstract

    BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). 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 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.

    CONCLUSIONS: 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.

    Original languageEnglish
    Pages (from-to)594-601
    Number of pages8
    JournalBritish Journal of Dermatology
    Volume174
    Issue number3
    Early online date16 Oct 2015
    DOIs
    Publication statusPublished - Mar 2016

    Fingerprint

    Hemangioma
    Propranolol
    Therapeutics
    Odds Ratio
    Confidence Intervals
    Surveys and Questionnaires
    Cosmetics
    Cohort Studies
    Maintenance
    Guidelines
    Hemorrhage
    Growth

    Keywords

    • Administration, Oral
    • Antineoplastic agents
    • Dose-response relationship, Drug
    • Female
    • Hemangioma
    • Humans
    • Infant
    • Male
    • Propranolol
    • Skin neoplasms
    • treatment outcome
    • Journal article
    • Multicenter study
    • Observational study
    • Research support, Non-U.S. Gov't

    Cite this

    Wedgeworth, E ; Glover, M ; Irvine, A D ; Neri, I ; Baselga, E ; Clayton, T H ; Beattie, P E ; Bjerre, J V ; Burrows, N P ; Foelster-Holst, R ; Hedelund, L ; Hernandez-Martin, A ; Audrain, H ; Bhate, K ; Brown, S J ; Baryschpolec, S ; Darne, S ; Durack, A ; Dvorakova, V ; Gach, J ; Goldstraw, N ; Goodyear, H ; Grabczynska, S ; Greenblatt, D ; Halpern, J ; Hearn, R M R ; Hoey, S ; Hughes, B ; Jayaraj, R ; Johansson, E K ; Lam, M ; Leech, S ; O'Regan, G M ; Morrison, D ; Porter, W ; Ramesh, R ; Schill, T ; Shaw, L ; Taylor, A E M ; Taylor, R ; Thomson, J ; Tiffin, P ; Tsakok, M ; Janmohamed, S R ; Laguda, B ; McPherson, T ; Oranje, A P ; Patrizi, A ; Ravenscroft, J C ; Shahidullah, H ; Solman, L ; Svensson, A ; Wahlgren, C F ; Hoeger, P H ; Flohr, C. / Propranolol in the treatment of infantile haemangiomas : lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. In: British Journal of Dermatology. 2016 ; Vol. 174, No. 3. pp. 594-601.
    @article{3dd7ef08e504462da1e7adfaec9dd563,
    title = "Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey",
    abstract = "BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). 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 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.CONCLUSIONS: 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.",
    keywords = "Administration, Oral, Antineoplastic agents, Dose-response relationship, Drug, Female, Hemangioma, Humans, Infant, Male, Propranolol, Skin neoplasms, treatment outcome, Journal article, Multicenter study, Observational study, Research support, Non-U.S. Gov't",
    author = "E Wedgeworth and M Glover and Irvine, {A D} and I Neri and E Baselga and Clayton, {T H} and Beattie, {P E} and Bjerre, {J V} and Burrows, {N P} and R Foelster-Holst and L Hedelund and A Hernandez-Martin and H Audrain and K Bhate and Brown, {S J} and S Baryschpolec and S Darne and A Durack and V Dvorakova and J Gach and N Goldstraw and H Goodyear and S Grabczynska and D Greenblatt and J Halpern and Hearn, {R M R} and S Hoey and B Hughes and R Jayaraj and Johansson, {E K} and M Lam and S Leech and O'Regan, {G M} and D Morrison and W Porter and R Ramesh and T Schill and L Shaw and Taylor, {A E M} and R Taylor and J Thomson and P Tiffin and M Tsakok and Janmohamed, {S R} and B Laguda and T McPherson and Oranje, {A P} and A Patrizi and Ravenscroft, {J C} and H Shahidullah and L Solman and A Svensson and Wahlgren, {C F} and Hoeger, {P H} and C Flohr",
    note = "This study had no specific funding. C.F. holds a U.K. National Institute for Health Research (NIHR) Career Development Fellowship (CDF-2014-07-037). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the U.K. Department of Health. S.J.B. holds a Wellcome Trust Intermediate Clinical Fellowship (086398/Z/08/Z).",
    year = "2016",
    month = "3",
    doi = "10.1111/bjd.14233",
    language = "English",
    volume = "174",
    pages = "594--601",
    journal = "British Journal of Dermatology",
    issn = "0007-0963",
    publisher = "Wiley",
    number = "3",

    }

    Wedgeworth, E, Glover, M, Irvine, AD, Neri, I, Baselga, E, Clayton, TH, Beattie, PE, Bjerre, JV, Burrows, NP, Foelster-Holst, R, Hedelund, L, Hernandez-Martin, A, Audrain, H, Bhate, K, Brown, SJ, Baryschpolec, S, Darne, S, Durack, A, Dvorakova, V, Gach, J, Goldstraw, N, Goodyear, H, Grabczynska, S, Greenblatt, D, Halpern, J, Hearn, RMR, Hoey, S, Hughes, B, Jayaraj, R, Johansson, EK, Lam, M, Leech, S, O'Regan, GM, Morrison, D, Porter, W, Ramesh, R, Schill, T, Shaw, L, Taylor, AEM, Taylor, R, Thomson, J, Tiffin, P, Tsakok, M, Janmohamed, SR, Laguda, B, McPherson, T, Oranje, AP, Patrizi, A, Ravenscroft, JC, Shahidullah, H, Solman, L, Svensson, A, Wahlgren, CF, Hoeger, PH & Flohr, C 2016, 'Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey', British Journal of Dermatology, vol. 174, no. 3, pp. 594-601. https://doi.org/10.1111/bjd.14233

    Propranolol in the treatment of infantile haemangiomas : lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. / Wedgeworth, E; Glover, M; Irvine, A D; Neri, I; Baselga, E; Clayton, T H; Beattie, P E; Bjerre, J V; Burrows, N P; Foelster-Holst, R; Hedelund, L; Hernandez-Martin, A; Audrain, H; Bhate, K; Brown, S J; Baryschpolec, S; Darne, S; Durack, A; Dvorakova, V; Gach, J; Goldstraw, N; Goodyear, H; Grabczynska, S; Greenblatt, D; Halpern, J; Hearn, R M R; Hoey, S; Hughes, B; Jayaraj, R; Johansson, E K; Lam, M; Leech, S; O'Regan, G M; Morrison, D; Porter, W; Ramesh, R; Schill, T; Shaw, L; Taylor, A E M; Taylor, R; Thomson, J; Tiffin, P; Tsakok, M; Janmohamed, S R; Laguda, B; McPherson, T; Oranje, A P; Patrizi, A; Ravenscroft, J C; Shahidullah, H; Solman, L; Svensson, A; Wahlgren, C F; Hoeger, P H; Flohr, C (Lead / Corresponding author).

    In: British Journal of Dermatology, Vol. 174, No. 3, 03.2016, p. 594-601.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Propranolol in the treatment of infantile haemangiomas

    T2 - lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey

    AU - Wedgeworth, E

    AU - Glover, M

    AU - Irvine, A D

    AU - Neri, I

    AU - Baselga, E

    AU - Clayton, T H

    AU - Beattie, P E

    AU - Bjerre, J V

    AU - Burrows, N P

    AU - Foelster-Holst, R

    AU - Hedelund, L

    AU - Hernandez-Martin, A

    AU - Audrain, H

    AU - Bhate, K

    AU - Brown, S J

    AU - Baryschpolec, S

    AU - Darne, S

    AU - Durack, A

    AU - Dvorakova, V

    AU - Gach, J

    AU - Goldstraw, N

    AU - Goodyear, H

    AU - Grabczynska, S

    AU - Greenblatt, D

    AU - Halpern, J

    AU - Hearn, R M R

    AU - Hoey, S

    AU - Hughes, B

    AU - Jayaraj, R

    AU - Johansson, E K

    AU - Lam, M

    AU - Leech, S

    AU - O'Regan, G M

    AU - Morrison, D

    AU - Porter, W

    AU - Ramesh, R

    AU - Schill, T

    AU - Shaw, L

    AU - Taylor, A E M

    AU - Taylor, R

    AU - Thomson, J

    AU - Tiffin, P

    AU - Tsakok, M

    AU - Janmohamed, S R

    AU - Laguda, B

    AU - McPherson, T

    AU - Oranje, A P

    AU - Patrizi, A

    AU - Ravenscroft, J C

    AU - Shahidullah, H

    AU - Solman, L

    AU - Svensson, A

    AU - Wahlgren, C F

    AU - Hoeger, P H

    AU - Flohr, C

    N1 - This study had no specific funding. C.F. holds a U.K. National Institute for Health Research (NIHR) Career Development Fellowship (CDF-2014-07-037). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the U.K. Department of Health. S.J.B. holds a Wellcome Trust Intermediate Clinical Fellowship (086398/Z/08/Z).

    PY - 2016/3

    Y1 - 2016/3

    N2 - BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). 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 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.CONCLUSIONS: 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.

    AB - BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). 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 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.CONCLUSIONS: 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.

    KW - Administration, Oral

    KW - Antineoplastic agents

    KW - Dose-response relationship, Drug

    KW - Female

    KW - Hemangioma

    KW - Humans

    KW - Infant

    KW - Male

    KW - Propranolol

    KW - Skin neoplasms

    KW - treatment outcome

    KW - Journal article

    KW - Multicenter study

    KW - Observational study

    KW - Research support, Non-U.S. Gov't

    U2 - 10.1111/bjd.14233

    DO - 10.1111/bjd.14233

    M3 - Article

    VL - 174

    SP - 594

    EP - 601

    JO - British Journal of Dermatology

    JF - British Journal of Dermatology

    SN - 0007-0963

    IS - 3

    ER -