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; 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

doi: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

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

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 (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

70 Citations (Scopus)

455 Downloads (Pure)

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 language	English
Pages (from-to)	594-601
Number of pages	8
Journal	British Journal of Dermatology
Volume	174
Issue number	3
Early online date	16 Oct 2015
DOIs	https://doi.org/10.1111/bjd.14233
Publication status	Published - 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

Access to Document

10.1111/bjd.14233

Author Accepted ManuscriptAccepted author manuscript, 264 KB

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

@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 = mar,

doi = "10.1111/bjd.14233",

language = "English",

volume = "174",

pages = "594--601",

journal = "British Journal of Dermatology",

issn = "0007-0963",

publisher = "Oxford University Press",

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

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

C2 - 26473312

SN - 0007-0963

VL - 174

SP - 594

EP - 601

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 3

ER -

Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey

Abstract

Keywords

Access to Document

Fingerprint

Cite this