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 GachN 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

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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

    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

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  • 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., ... 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, 174(3), 594-601. https://doi.org/10.1111/bjd.14233