Oral atenolol therapy for proliferating infantile hemangioma: A prospective study

Abstract

Propranolol, a lipophilic nonselective β-blocker, has recently been reported to be the treatment of choice for select types of infantile hemangiomas (IHs). Atenolol is a hydrophilic, selective β1-blocker and therefore may be not associated with side effects attributable to β2-adrenergic receptor blockade and lipophilicity. However, the efficacy and safety of atenolol in the treatment of IH are poorly understood. The aim of this study was to evaluate the efficacy and safety of atenolol in the treatment of proliferating IHs.A study of 76 infants between the ages of 5 to 20 weeks with superficial or mixed IH was conducted between August 2013 and March 2015. Oral atenolol was administered in a progressive schedule to 1 mg/kg per day in a single dose. Efficacy was assessed using the Hemangioma Activity Score (HAS) at weeks 0, 1, 4, 12, and 24. Safety was evaluated at weeks 0, 1, 4, 8, 12, 16, 20, and 24.In total, 70 patients completed 24 weeks of treatment. IH growth abruptly stopped for 93.4% of patients within the fourth week of treatment with atenolol. In ulcerated IHs, complete healing of the ulcerations occurred in an average treatment time of 5.5 weeks. Atenolol treatment promoted dramatic decreases in HAS scores after week 1. An "excellent" treatment response (compete or nearly complete resolution of the IH) was observed in 56.5% of patients at week 24. No significant hypoglycemia, bronchospasm, bradycardia, or hypotension occurred. The most common adverse event was diarrhea, followed by agitation and sleep disturbance.This study demonstrated that atenolol was effective and safe at a dose of 1 mg/kg per day for 24 weeks in the treatment of proliferating IHs.

Figure 1

A girl with left subaural infantile hemangioma (IH) treated with atenolol. (A) At 3 weeks of age, 2 weeks before treatment with atenolol. Clinical photographs of IH at baseline (B), 1 (C), 4 (D), 12 (E), and 24 (F) weeks after the start of treatment. IH = infantile hemangioma.

Figure 2

Clinical photographs of patients treated with atenolol showing changes in the color and size of the lesion at weeks 0, 1, 4, 12, and 24: (A) 5-week-old girl with right temporal IH; (B) 6-week-old girl with IH on the left forearm; (C) 8-week-old girl with mixed IH on the left chest; (D) 10-week-old boy with IH on the left shoulder; (e) 20-week-old girl with IH on the right shoulder. IH = infantile hemangioma.

Figure 3

A 9-week-old boy with ulcerated IH on the scrotum. Clinical photographs of IH at baseline (A), 1 (B), 4 (C), 12 (D), and 24 (E) weeks after the start of treatment. IH = infantile hemangioma.

Figure 4

Hemangioma Activity Score (HAS) of the efficacy of atenolol. The efficacy of atenolol was scored at week 0, 1, 4, 12, and 24. HAS = Hemangioma Activity Score.

Figure 5

Changes in the heart rate during atenolol treatment: (A) the mean heart rate before and after the first dose of atenolol at week 0; (B) the mean heart rate before and after the first dose adjustment at week 1.