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. 2023 Mar-Apr;68(2):148-155.
doi: 10.4103/ijd.ijd_867_22.

Comparing the Effectiveness of Propranolol versus Atenolol in Inducing Clinical Clearance in the Treatment of Infantile Haemangioma: A Randomised Controlled Trial

Raihan Ashraf  1 , Rahul Mahajan  1 , Muneer A Malik  2 , Sanjeev Handa  1 , Anindita Sinha  3 , Dipankar De  1 , Naresh Sachdeva  4
Affiliations

Comparing the Effectiveness of Propranolol versus Atenolol in Inducing Clinical Clearance in the Treatment of Infantile Haemangioma: A Randomised Controlled Trial

Raihan Ashraf et al. Indian J Dermatol. 2023 Mar-Apr.

Abstract

Background: Despite the excellent clinical efficacy of oral propranolol in the management of infantile haemangiomas (IHs), there is a need to further evaluate other beta blockers that may be equally efficacious but result in lesser adverse effects. We compared the efficacy and short-term safety of atenolol, a hydrophilic cardio-selective beta blocker, with propranolol, in the treatment of IHs.

Materials and methods: Sixty patients with complicated and/or cosmetically significant IHs were randomised into two groups, oral propranolol group (2 mg/kg/day) and the oral atenolol (1 mg/kg/day) group, respectively, for 9 months. Patients were assessed clinically, by the use of Doppler ultrasonography (USG) and measurement of serum hypoxia-inducible factor 1 alpha (HIF-1α).

Results: Twenty-two of 30 patients achieved complete clearance in the propranolol group (0.73; 95% CI = 0.54 to 0.87) compared with 13 of 25 patients in the atenolol group (0.52; 95% CI = 0.31 to 0.72). The mean time to achieve Physician Global Assessment Score 5 (PGA5) (25.00 ± 8.87 weeks) was significantly lesser in the propranolol group versus the atenolol group (31.69 ± 7.01 weeks; log-rank = 0.04). The two groups were comparable in terms of adverse effect profile, degree of volume reduction in USG and reduction in HIF-1α levels.

Conclusions: Propranolol (2 mg/kg/day) is better than atenolol (1 mg/kg/day) in inducing complete clinical clearance of IH although the results need to be reproduced in larger studies.

Keywords: Atenolol; infantile haemangioma; propranolol.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the study
Figure 2
Figure 2
Survival time-to-event analysis (Kaplan–Meier curve) of patients achieving PGA5 over 36 weeks
Figure 3
Figure 3
Infantile haemangiomas. (a-d) Clinical photographs of a patient in group A (propranolol) at baseline (HAS = 5), 3 months (HAS = 3), 6 months (HAS = 0.5) and 9 months (HAS = 0.5), respectively. (e-h) Clinical photographs of a patient in group B (atenolol) at baseline (HAS = 6), 3 months (HAS = 3), 6 months (HAS = 3) and 9 months (HAS = 1), respectively. HAS = Hemangioma Activity Score
Figure 4
Figure 4
Infantile haemangiomas. (a-d) Clinical photographs of a patient in group A (propranolol) at baseline (HAS = 5.5), 3 months (HAS = 4), 6 months (HAS = 0) and 9 months (HAS = 0), respectively. (e-h) Clinical photographs of a patient in group B (atenolol) at baseline (HAS = 6), 3 months (HAS = 4), 6 months (HAS = 3) and 9 months (HAS = 1.3), respectively. HAS = Haemangioma Activity Score
See this image and copyright information in PMC

References

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