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. 2024 Dec 2:15:1515901.
doi: 10.3389/fphar.2024.1515901. eCollection 2024.

Efficacy and safety of oral propranolol and topical timolol in the treatment of infantile hemangioma: a meta-analysis and systematic review

Xiaoye Huang #  1   2 , Wenyue Si #  3 , Zhili Zou  4 , Binyao Li  1 , Yide Mu  1 , Wei Zhong  1 , Kaiying Yang  1
Affiliations

Efficacy and safety of oral propranolol and topical timolol in the treatment of infantile hemangioma: a meta-analysis and systematic review

Xiaoye Huang et al. Front Pharmacol. .

Abstract

Background: Propranolol, a nonselective β-blocker, is the first-line treatment for infantile hemangioma (IH). Topical timolol has recently been proposed as a novel IH treatment with fewer adverse effects. This study was conducted to compare the efficacy and safety of oral propranolol and topical timolol for treating IH.

Methods: Studies were included after searching PubMed, Embase, Web of Science, and the Cochrane Library via the keywords of "propranolol", "timolol", "infantile hemangioma" and their synonyms. A meta-analysis with pooled odds ratios was performed using the fixed-effect model.

Results: Seven articles with 2071 patients were included in this meta-analysis. Compared with topical timolol, oral propranolol had a greater response rate (OR = 2.12, P < 0.001), but it was also associated with a greater risk of adverse events (OR = 2.31, P < 0.001). For superficial IH, timolol demonstrated similar efficacy to propranolol (OR = 1.28, P = 0.34) but with fewer adverse events (OR = 2.30, P = 0.001). Additionally, compared with topical timolol, propranolol at a dosage of 2 mg/kg/d had a better response rate (OR = 2.62, P < 0.001), whereas the 1.0∼1.5 mg/kg/d propranolol group showed no significant difference (OR = 1.34, P = 0.38).

Conclusion: Oral propranolol presents superior therapeutic efficacy in the treatment of IH compared to topical timolol. However, topical timolol can serve as an alternative to oral propranolol for treating superficial IH, providing similar efficacy with fewer adverse effects. Additionally, propranolol at a dosage of 2 mg/kg/d offers greater efficacy with a comparable safety profile, whereas the 1.0∼1.5 mg/kg/d propranolol dosage shows no significant difference in efficacy compared to timolol but is associated with more adverse events.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024603724, identifier CRD42024603724.

Keywords: efficacy and safety; infantile hemangioma; meta-analysis; propranolol; timolol.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA diagram.
FIGURE 2
FIGURE 2
Forest plot of (A) efficacy and (B) adverse events.
FIGURE 3
FIGURE 3
Forest plot of (A) efficacy in treating superficial IH and (B) adverse events of superficial IH.
FIGURE 4
FIGURE 4
Forest plot of (A) efficacy and (B) adverse events associated with different dosages of propranolol.
FIGURE 5
FIGURE 5
Publication bias evaluation and sensitivity analysis. (A) Funnel plots of response rates for the meta-analysis comparing topical timolol and oral propranolol for treating IH. (B) Funnel plots of safety outcomes for the meta-analysis comparing topical timolol and oral propranolol for treating IH. (C) Sensitivity analysis of response rates for the meta-analysis comparing topical timolol and oral propranolol for treating IH. (D) Sensitivity analysis of safety outcomes for the meta-analysis comparing topical timolol and oral propranolol for treating IH.
See this image and copyright information in PMC

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