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

• Published in: British journal of dermatology (1951) Vol. 174; no. 3; pp. 594 - 601
• Main 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.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.03.2016
• Subjects: Administration, Oral; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Clinical Medicine; Dermatologi och venereologi; Dermatology and Venereal Diseases; Dose-Response Relationship, Drug; Female; Hemangioma - drug therapy; Humans; Infant; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Propranolol - administration & dosage; Propranolol - adverse effects; Skin Neoplasms - drug therapy; Treatment Outcome
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/bjd.14233

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, 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. What's already known about this topic? Oral propranolol is widely prescribed as first‐line treatment for complicated infantile haemangiomas. Anecdotally, prescribing practice differs widely, but no international survey has been undertaken to date. What does this study add? This is the first European study of current practice in the use of oral propranolol in infantile haemangiomas, based on the largest case series of its kind. The PITCH survey confirms the overall efficacy and safety of propranolol, with the majority of paediatric dermatologists using 2 mg kg−1 per day as a therapeutic dose. Any future clinical trial should therefore include a 2 mg kg−1 per day treatment arm. Plain language summary available online