The response pattern and adherence to oral propranolol among Saudi children treated for infantile hemangioma

Abstract

Background

Although the role of oral propranolol in treating IH is now well-recognized worldwide, the variation of treatment effectiveness over time and patients adherence have not been documented among Saudi.

Objective

To identify the variation of effectiveness over the treatment period and the adherence to treatment of oral propranolol among Saudi children treated for infantile hemangiomas (IH).

Patients and methods

Children presented for treatment of problematic IH between February 2012 and September 2015 were recruited in a prospective observational study of oral propranolol at 2 mg/kg/day. Data about patients’ adherence (categorized based compliance with the scheduled visits and treatment administration), lesion comparative response score (based on the relative improvement compared to previous visit) and possible side-effects were collected during follow-up. Treatment was stopped once the lesions failed to show significant improvement. Serial digital photography was used for response and final outcome assessments.

Results

Thirty-six cases were enrolled at a median (range) age of 6 (2–55) months. Cases were classified as 19 minor and 17 major, including 10 with ulcerations. Adherence was poor in 12 (33.3%), moderate in 4 (11.1%) and good in 19 (52.8%). Excluding the poorly adherent, the mean duration of treatment and follow up were 6 ± 3.4 and 7 ± 4.6 months, respectively. A mean comparative response score of 1.67 from a maximum of 2 was achieved during the first month of treatment, then gradually diminished reaching 0.19 and 0 at 8 and 10 months respectively. Patients who successfully completed 6 months of treatment (n = 19) were more likely to present with major lesions (68.4% vs. 33.3%, P = 0.047) and at an earlier median age (4 vs. 11 months, P = 0.018). Complete or near complete responses was 47% achieved. All ulcerated lesions healed at a median of 2 (1–4) months.

Conclusion

The most dramatic response to treatment appeared during the first month, then progressively diminished toward negligible benefits beyond 8 months. Adherence to treatment can pose a challenge to achieving satisfactory outcomes.