What is the best time for withdrawal of propranolol in infants with infantile hemangiomas?

Relapse of infantile hemangiomas (IHs) after withdrawal from propranolol treatment is common. Early withdrawal is believed to increase the risk of relapse. A study was done to determine the optimal time to discontinue propranolol treatment for IHs.A prospective study conducted at a tertiary referral center. RESULTS: Compared to withdrawal after 1-month maintenance treatment, withdrawal after 3-months maintenance, corresponding achieving maximum regression of IHs, was associated with a lower major relapse rate (P=0.041). The relapse (P=0.055) and adverse event rates (P=0.154) between the two withdrawal modes were not statistically significant. Compared with direct withdrawal, the relapse (P=0.396), major relapse (P=0.963), and adverse event rates (P=0.458) of gradual withdrawal were not statistically different. Patients with/without relapse could be best distinguished according to whether withdrawal followed a 3-months maintenance and age >13 months (AUC=0.603). Patients with/without major relapse could be best distinguished according to whether withdrawal was accompanied by 3-months maintenance (AUC=0.610). The optimal propranolol withdrawal time to avoid relapse is when the patient is aged >13 months and the lesion has maintained for 3 months after reaching maximum regression, while the optimal time to prevent major relapse is after 3 months of maintenance.

Reference:

Journal of the American Academy of Dermatology. Exploration of the Optimal Time to Discontinue Propranolol Treatment in Infantile Hemangiomas: A Prospective Study. J Am Acad Dermatol 2023 Dec 28;[EPub Ahead of Print], L Wang, W Wang Mm, Z Zhou, J Li, Z Li, R Lv, G Xu, J Bi, R Huo

Keywords:

the Journal of the American Academy of Dermatology, Propranolol Treatment, Infantile Hemangiomas, L Wang, W Wang Mm, Z Zhou, J Li, Z Li, R Lv, G Xu, J Bi, R Huo