Medical Management of Infantile Hemangioma: Is oral Propranolol Superior to Oral Prednisolone?

Objective: To compare the efficacy of oral propranolol versus oral prednisolone for treating infantile hemangioma. Methodology: This randomized controlled trial was conducted at the Department of Plastic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January 2015 to December 2016. Written informed consent was taken from the parents. The trial included 80 patients who were randomly assigned to two treatment groups, each comprising of 40 patients. Patients in Group-A received oral propranolol treatment, whereas patients in the Group-B received oral prednisolone treatment. Greater than 75% regression in size (as determined by the length, width, and height measured in millimeters) of the hemangioma as compared to the pre-treatment status was determined for each group and comparisons were drawn. The percentages of various outcome variables were compared by employing chi-square test. A p-value of less than or equal to 0.05 was regarded as statistically significant. Results: The age of the children ranged from 1-36 months, with a mean of 15.20±10.40 months. The majority (n=51, 63.8%) of them were aged between 1-18 months. There were 33 (41.3%) male whereas 47 (58.7%) female children. Maximal possible matching of the two groups was ensured with regards to the various demographic and clinical entry parameters. The frequency of efficacy was significantly higher (92.5% vs. 25.0%; p=0.000) with propranolol as compared to prednisolone. Similar significant difference was seen across all age and gender groups. Conclusion: Propranolol had superior efficacy, 6-weeks post-treatment irrespective of the patients’ age and gender. Hence, oral propranolol should be the preferred choice for treating infantile hemangiomas.