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

Xiaoye Huang; Wenyue Si; Zhili Zou; Binyao Li; Yide Mu; Wei Zhong; Kaiying Yang

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

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

Authors

Xiaoye Huang^#^{1

2}, Wenyue Si^#³, Zhili Zou⁴, Binyao Li¹, Yide Mu¹, Wei Zhong¹, Kaiying Yang¹

Affiliations

¹ Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, National Children's Medical Center for South Central Region, Guangzhou Medical University, Guangzhou, China.
² School of Pediatrics, Guangzhou Medical University, 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.

^# Contributed equally.

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.

Publication types

Systematic Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the grant National Natural Science Foundation of China (Grant NO. 82370526); the China Postdoctoral Science Foundation (2023M730793); the Guangdong Basic and Applied Basic Research Foundation (2023A1515012751); the Guangzhou Basic and Applied Basic Research Foundation (2024A04J3857); the Research Foundation of Guangzhou Women and Children’s Medical Center for Clinical Doctors (2023BS014).