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Propranolol superior to captopril in treating infantile hemangioma

Patients with infantile hemangioma had better responses and greater benefit with propranolol treatment compared with captopril, according to recently published study results.

Researchers studied 30 patients (mean age, 6.3 months; 60% female) with problematic infantile hemangioma and 35 age- and sex-matched healthy controls, who were randomly assigned propranolol or captopril treatment.  Half of the patients with infantile hemangioma received oral propranolol (2 mg/kg per day, divided into two daily doses), while the other 15 patients received oral captopril (0.5-1 mg/kg per day, in a titrating dose).

“Assessment was done clinically and by measurement of serum vascular endothelial growth factor and angiotensin II in patients and control subjects,” the researchers wrote.

The researchers also assessed the angiotensin-covering enzyme gene polymorphism.

Change in infantile hemangioma color from intense red to lighter purple-blue color, associated with palpable softening of the lesion, was noted in both patients group, with initial response appearing earlier in the propranolol-treated cohort (4.66 ± 1.24 weeks) compared with the captopril-treated patients (6.93 ± 1.73 weeks; P = .03).  There was a shorter endpoint of treatment for the propranolol cohort compared with the captopril cohort (7.87 ± 1.64 months vs. 11 ± 2.42 months; P = .01). All patients treated with propranolol displayed clinical improvement in infantile hemangioma, with excellent final response documented in 35% of patients, moderate final response in 45% of patients and mild final response in 20% of the patients. In the captopril-treated patients, no patients showed excellent final response, 13.3% showed moderate final response, 53.3% showed mild final response and 33.3% showed poor final response.

Reduced vascular endothelial growth factor and angiotensin II levels were shown in both cohorts following treatment; however, the propranolol-treated patients had a significantly higher percentage reduction.

Patients in the captopril-treated cohort reported cardiac side effects.

“Baseline vascular endothelial growth factor level was significantly higher and endothelial growth factor level was significantly higher and baseline angiotensin II level was significantly lower, in patients than control subjects,” the researchers wrote.

“Although our study suggests that propranolol is preferable to captopril in the treatment of [infantile hemangioma], the potential efficacy of captopril cannot be discounted, as higher doses with careful monitoring might yield better results.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.