Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. (1st March 2016)

• Record Type: Journal Article
• Authors: 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.;
• Is Part Of: British journal of dermatology. Volume 174:Number 3(2016)
• Page Start: 594
• Page End: 601
• Publication Date: 2016-03-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.14233
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: 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, P trend < 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.