Atenolol shows promise in managing problematic infantile hemangiomas:JAMA

Propranolol has become the first-line therapy for problematic infantile hemangiomas (IHs) that require systemic therapy. However, different adverse events have been reported during propranolol treatment. The positive efficacy and safety of atenolol raise the question of whether it could be used as a promising therapy for IH.

A team of researchers from the West China Hospital of Sichuan University, undertook the recent study to compare the efficacy and safety of propranolol vs atenolol in infants (between age 5 and 20 weeks) with problematic IHs who required systemic therapy.

This was a prospective, multicenter, randomized, controlled, open-label clinical trial conducted in collaboration among 6 separate investigation sites in China from February 1, 2015, to December 31, 2018. A total of 377 patients met the criteria for inclusion and were randomized to the propranolol (190 [50.4%]) and atenolol (187 [49.6%]) groups. Data were analyzed in June 2020. Participants were randomized to receive either propranolol or atenolol for at least 6 months. They completed efficacy assessments at 2 years after the initial treatment.

The primary outcome was any response or nonresponse at 6 months. The key secondary outcome was changes in the hemangioma activity score.

Results revealed some interesting facts.

• Of 377 participants, 287 (76.1%) were female, and the mean (SD) age was 10.2 (4.0) weeks in the propranolol group and 9.8 (4.1) weeks in the atenolol group.
• After 6 months of treatment, in the propranolol and atenolol groups, the overall response rates were 93.7% and 92.5%, respectively (difference, 1.2%; 95% CI, −4.1% to 6.6%).
• At 1 and 4 weeks after treatment, and thereafter, the hemangioma activity score in the atenolol group aligned with the propranolol group (odds ratio, 1.034; 95% CI, 0.886-1.206).
• No differences between the propranolol group and atenolol group were observed in successful initial responses, quality of life scores, complete ulceration healing times, or the rebound rate.
• Both groups presented a similar percentage of complete/nearly complete responses at 2 years (82.1% vs 79.7%; difference, 2.4%; 95% CI, −5.9% to 10.7%).
• Adverse events were more common in the propranolol group (70.0% vs 44.4%; difference, 25.6%; 95% CI, 15.7%-34.8%), but the frequency of severe adverse events did not differ meaningfully between the groups.

"The results from this prospective, multicenter, randomized clinical trial suggest that, compared with propranolol treatment, atenolol treatment provided equivalent efficacy outcomes as an initial treatment for problematic IHs in early and late follow-up. In addition, these findings reveal that, compared with propranolol, atenolol produced a comparable rebound growth rate and better tolerance. These results indicate that atenolol is an effective and safe therapy for problematic IHs. Atenolol can be used as a first-line treatment for problematic IHs that require systemic treatment or as an alternative treatment for patients who cannot tolerate or have a contraindication to propranolol."the team concluded.

For full article follow the link: doi:10.1001/jamaoto.2021.0454

Primary source: JAMA Otolaryngology Head Neck Surgery.