Atenolol as good as propranolol for problematic infantile hemangiomas: JAMA
According to recent research, it has been observed that when compared with propranolol, atenolol had similar efficacy and fewer adverse events in the treatment of infants with problematic infantile hemangiomas.
The study is published in the JAMA Otolaryngology–Head & Neck Surgery.
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 infantile hemangiomas.
Hence, Yi Ji and colleagues from the Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China conducted the present 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.
The authors carried out a a prospective, multicenter, randomized, controlled, open-label clinical trial in collaboration among 6 separate investigation sites in China. 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. The data was then analyzed.
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.
The results showed that-
a. 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.
b. 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%).
c. 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).
d. 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.
e. 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%).
f. 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.
Therefore, the authors concluded that " when compared with propranolol, atenolol had similar efficacy and fewer adverse events in the treatment of infants with problematic Ihs."
The results suggest that oral atenolol can be used as an alternative treatment option for patients with IH who require systemic therapy, they further added.
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