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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Obstetric and Pediatric Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1515901

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

Provisionally accepted
Xiaoye Huang Xiaoye Huang 1,2Wenyue Si Wenyue Si 3Zhili Zou Zhili Zou 4Binyao Li Binyao Li 2Yide Mu Yide Mu 2Wei Zhong Wei Zhong 2*Kaiying Yang Kaiying Yang 2*
  • 1 School of Pediatrics, Guangzhou Medical University, Guangzhou, China
  • 2 Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China
  • 3 Department of Science Research and Education Management, Guangzhou Women and Children's Medical Center, National Children's Medical Center for South Central Region, Guangzhou Medical University, Guangzhou, China
  • 4 The First School of Clinical Medicine, Guangzhou Medical University, Guangzhou, China

The final, formatted version of the article will be published soon.

    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 2 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 daily had a better response rate (OR = 2.62, P < 0.001), whereas the 1.0~1.5mg/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 daily 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.

    Keywords: infantile hemangioma, Propranolol, Timolol, efficacy and safety, Meta-analysis

    Received: 23 Oct 2024; Accepted: 21 Nov 2024.

    Copyright: © 2024 Huang, Si, Zou, Li, Mu, Zhong and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Wei Zhong, Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China
    Kaiying Yang, Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.