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Br J Dermatol. 2016 Mar;174(3):594-601. doi: 10.1111/bjd.14233. Epub 2015 Dec 26.

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

Author information

1
Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, U.K.
2
Department of Paediatric Dermatology, Great Ormond Street Hospital NHS Foundation Trust, London, U.K.
3
National Children's Research Centre & Department of Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland.
4
Dermatology Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
5
Pediatric Dermatology Unit, Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
6
Department of Paediatric Dermatology, Royal Manchester Children's Hospital, Manchester, U.K.
7
Department of Paediatric Dermatology, Royal Hospital for Children, Glasgow, U.K.
8
Department of Paediatrics, University Hospital Aarhus, Aarhus, Denmark.
9
Department of Dermatology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
10
Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
11
Department of Dermatology, University Hospital Aarhus, Aarhus, Denmark.
12
Department of Dermatology, Hospital Infantil Niño Jesús, Madrid, Spain.
13
Department of Paediatric Dermatology, University Hospitals Bristol NHS Foundation Trust, Bristol, U.K.
14
Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham, U.K.
15
Department of Dermatology, Ninewells Hospital and Medical School, Dundee, U.K.
16
Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, U.K.
17
Department of Dermatology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, U.K.
18
Department of Dermatology, University Hospitals Coventry and Warwickshire, Coventry, U.K.
19
Department of Dermatology, St George's University Hospitals NHS Foundation Trust, London, U.K.
20
Department of Paediatric Dermatology, Heart of England NHS Foundation Trust, Birmingham, U.K.
21
Department of Dermatology, Buckinghamshire Healthcare NHS Trust, Amersham, U.K.
22
Department of Dermatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K.
23
Department of Dermatology, Royal Victoria Hospital, Belfast, U.K.
24
Department of Paediatrics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, U.K.
25
Dermatological and Venereal Clinic, Södersjukhuset, Stockholm, Sweden.
26
Department of Paediatric Dermatology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, U.K.
27
Department of Paediatric Ophthalmology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, U.K.
28
Department of Paediatric Dermatology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, U.K.
29
Departments of Paediatrics & Paediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
30
Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, U.K.
31
Department of Ophthalmology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, U.K.
32
Department of Dermatology, Oxford University Hospitals, Oxford, U.K.
33
Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklan 101, 1090, Brussels, Belgium.
34
Department of Paediatric Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, U.K.
35
Department of Dermatology (Paediatric Dermatology and Hair), Dermicis, Alkmaar and Foundation/Network for Pediatric Dermatology Rotterdam, Rotterdam, the Netherlands.
36
Department of Dermatology, Derby NHS Foundation Trust, Derby, U.K.
37
Lund University, Institute of Clinical Research in Malmö, Skåne University Hospital, Department of Dermatology, Malmö, Sweden.
38
Dermatology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.

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.

PMID:
26473312
DOI:
10.1111/bjd.14233
[Indexed for MEDLINE]

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