A Meta-analysis On The Effectiveness Of Oral Propranolol For The Treatment Of Infantile Hemangiomas

Background:Infantile hemangiomas are the most common benign tumors of infancy, affecting5-10%of in Caucasian race,and are three times more common in girls. They can be differentiated from vascular malformations by their quick dynamic growth and slow spontaneous regression. About one third hemangiomas have some heralded signs. They are usually red punctuation, leuasmus, circumscribed angioectasis and so on. The neutral time of incidence of hemangioma is two weeks. About50%hemangioma regressed when five years old and70%regressed when seven years old. The hemangiomas are finally replaced by fat and fiber and40%-50%of the patients would have scars. But the hemangiomas can still cause disfigurement and serious complication depending on their location and size such as obstruction of airways and vision. And the regression can also be associated with painful ulcerations and hemorrhage. Standard treatment options for hemangioma include oral steroids, laser surgery, interferon, vincristine and cyclophosphamide in life-threatening cases. Each of these opinions has its restrictions and/or side effects. In2008, Leaute-Labreze et al described their observation of an antiproliferative effect of propranolol on IH. Propranolol has since become an effective therapy for IH. But steroids used to be the first choice therapy of IH. With the increase of research on propranolol, the first choice may change. So we want to give a systematic review of the research of this field and compare and assess the effectiveness of propranolol and steroids. Objective:The objective is to compare the effectiveness and complication between propranolol and steroids to clarify the curative effect of propranolol for IH. Meanwhile, this article will also provide evidence of evidence-based medicine.Method:A systematic search of Pub med, Cochrane library, Embase, Medline, Science Direct and Chinese biomedicine literature database(CBM), CNKI, VIP wanfang database, screening the published literatures of controlled clinical trial on this field by January,2013.We chose the standard by Sara H Downs and Nick Black to evaluate the quality of all the literatures included. And we use RevMan5.2to review the effectiveness, adverse effects, dosage, and time of treatment. We conducted the statistic analysis by typing all the statistics in this software of the clinical trial which satisfy the including criteria. The outcome was indicated by OR and95%CI. If all the statistics are homegenity, that is to say P>0.1and I2<50%, they will be analyzed by the fixed effect model. Otherwise, they will be analyzed by randomized effect model. The publication bias is showed by funnel plot.Results:110studies were identified by the strategy mentioned above. Of those only12articles met our inclusion criteria after review by two independent reviewers. Only9studies of8literatures met final inclusion criteria for meta-analysis. The experimental group of all the nine studies is propranolol group. Six of the control group is prednisone, there is no statistic heterogeneity (P=0.09, I2=0%). And we use the fixed model to analysis the statistics. The outcome shows the effectiveness to cure hemangioma of propranolol is higher than that of prednisone. And the difference is statistical significance[OR=7.56,95%CI(3.18,17.98)]. Three of the control group is observation of placebo, there is no statistic heterogeneity (P=0.09, I2=0%) too. And we use the fixed model to analysis the statistics. The outcome shows the effectiveness to cure hemangioma of propranolol is higher than that of the control group. And the difference is statistical significance [OR=25.98,95%CI(7.24,93.15)]. Of all the eight researches, six reported adverse effects. Especially, when the control group is prednisone, there were19(11%) the patients in propranolol group were reported to have adverse effect. While there were72(50%) patients in prednisone group. The most common adverse effect of propranolol is the decreased food appetite, nausea and vomiting, sleeping disorder.Conclusion:The results of this meta-analysis show that compared oral propranolol could obviously decrease the volume of infantile hemangioma, improve the color of IH. And propranolol is a significantly more effective treatment for IH than steroids. The incidence of adverse effects of propranolol is lower than that of prednisone. As a result, propranolol should be recommended as the first choice therapy for infantile hemangioma.