Beta-blockers versus corticosteroids in the treatment of infantile hemangioma: an evidence-based systematic review

Shi-Qiong Xu, Ren-Bing Jia, Wei Zhang, Huang Zhu, Sheng-Fang Ge, Xian-Qun Fan

Shanghai, China

Author Affiliations: Department of Ophthalmology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China (Xu SQ, Jia RB, Ge SF, Fan XQ); Department of Emergency, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China (Zhang W); Department of Ophthalmology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China (Zhu H)

Corresponding Author: Xian-Qun Fan, MD, PhD, Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Road, Shanghai 200011, China (Tel: 86-21-23271699; Email: fanxq@sh163.net)

doi: 10.1007/s12519-013-0427-z

Background: The efficacy and safety of beta-blockers versus corticosteroids in the treatment of infantile hemangiomas (IHs) is controversial. This study aimed to summarize evidence described in the literature and to assess the quality of studies involving beta-blockers and corticosteroids for the treatment of cutaneous IHs.

Methods: Comparative studies were collected from 15 online electronic databases, including OVID Medline, PubMed, ISI Web of Science, CENTRAL, CNKI, ChiCTR, JPCTR, CTRIndia, IranCTR, SLCTR, ISRCTRN, NLCTR, GCTR, ANCTR, ClinicalTrial.gov, and associated references. Studies without a control group were excluded, and the remaining studies were assessed by two reviewers independently using the Downs & Black scale for reported quality. The main areas assessed in the included studies were volume changes, overall improvement in appearance, eye function, and adverse events.

Results: Ten comparative studies were included with a total of 419 children. A meta-analysis was not performed due to the considerable heterogeneity across studies. Some evidence showed that beta-blockers are superior to steroids in reducing volume and improving the overall appearance of IHs, such as lightening of the color and flattening of the surface. Conclusions regarding improved eye function and adverse events were divided, and no consensus has been reached on the superiority of one treatment over another. No episodes of severe-onset asthma, hypotension, or bradycardia occurred in the beta-blocker treatment due to the rigorous exclusion of patients with contraindications.

Conclusions: Available studies indicate that beta-blockers are an alternative option to corticosteroids for IH treatment with respect to volume shrinkage and improvement in appearance. No evidence has shown a significant difference in improved eye function and adverse events between beta-blockers and corticosteroids in the treatment of IH; indeed, there is a lack of well-designed, high-quality randomized control trials.

Key words: adverse events; beta-blockers; eye functions; infantile hemangioma; steroids

World J Pediatr 2013;9(3):221-229