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Oral Nadolol for the Treatment of Infantile Hemangiomas: A Single‐Institution Retrospective Cohort Study
Author(s) -
Randhawa Harkamal Kaur,
Sibbald Cathryn,
Garcia Romero Maria Teresa,
Pope Elena
Publication year - 2015
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.12655
Subject(s) - medicine , nadolol , interquartile range , visual analogue scale , retrospective cohort study , discontinuation , dosing , cohort , clinical endpoint , surgery , propranolol , clinical trial
Abstract Background Beta‐blockers have become the treatment of choice for problematic infantile hemangiomas ( IH s). Nadolol, a nonselective beta‐blocker with potential dosing advantages and a better safety profile than that of other beta‐blockers, has been studied as an alternative therapeutic option. Our objective was to characterize the efficacy and safety of oral nadolol in the treatment of proliferating IH s. Methods A retrospective cohort study was conducted at the Hospital for Sick Children between February 2010 and April 2012 in patients treated with nadolol for proliferating IH s causing functional impairment or cosmetic disfigurement. The primary outcome was the percentage involution measured independently by two assessors who scored changes in the extent of IH s by comparing serial photographs using a 100‐mm visual analogue scale ( VAS ), on which 5 mm represented 10% change. Results Forty‐four patients treated with nadolol for IH s with adequate photographic documentation were identified. The median age at presentation was 4.5 months (interquartile range 1.5–7.9 mos). There was a mean improvement of 91.8 ± 11.1%. At least 50% improvement was noted in 42 (95%) patients and 75% improvement in 39 (89%) patients. The mean time to 50% and 75% improvement was 2.9 and 3.7 months, respectively. Analysis of variance showed that younger age at the time of treatment start was associated with a higher mean VAS score (% involution) (p < 0.05). Treatment duration (mean 9.5 ± 5.6 months) had no significant effect on VAS score. Test of interobserver correlation showed good agreement (intraclass correlation coefficient = 0.86, p = 0.001). Conclusions Oral nadolol is efficacious in patients with problematic IH s. Further large‐scale prospective comparative studies are warranted to compare nadolol with other beta‐blockers.