Researchers noted that infants who began propranolol therapy at higher dose had a lower incidence of adverse events.
To study the effect of treating infants with infantile hemangiomas (IHs) at the target dose of 2 mg/kg of propranolol per day from day 1 rather than the current recommended dose of 1 mg/kg per day and increasing to the target dose, study authors performed a retrospective study of 238 infants and children. The poster, “Regimen for Accelerated Propranolol Initial Dosing (RAPID),” was presented at the 2023 Society for Pediatric Dermatology Meeting, July 13-16, 2023, in Asheville, North Carolina.1
The study compared the incidence of adverse events (AEs) between infants starting propranolol at 1 mg/kg per day and those starting at 2 mg/kg per day. Participants were receiving outpatient therapy for uncomplicated IH from October 2018 to March 2021 at Children’s Hospital of Philadelphia.
Primary outcome measures were parent-reported incidence of AEs and patient vitals, which were taken at scheduled outpatient appointments.
Results showed that the participants who began propranolol treatment therapy at 2 mg/kg per day did not have a higher incidence of AEs compared to those who began at the current guidelines of 1 mg/kg per day and up-titrated to 2 mg/kg per day. The patients who began treatment at 1 mg/kg per day had a significantly higher rate of AEs (p = .018) and hypotension (p = .02).
In patients younger than 2 months versus patients over 2 months, there was no significant difference in incidence of AEs. The most common AEs were hypotension, sleep disturbances, and GI disturbances, all of which were higher in the group that initiated treatment at 1 mg/kg per day.
Infants who began propranolol treatment at the lower dose were significantly younger than those on the higher dose, which could explain the higher incidence of AEs.
The findings suggest that beginning propranolol treatment for uncomplicated IHs at the target dose of 2 mg/kg per day for infants and children could be an option for clinicians.