The response pattern and adherence to oral propranolol among Saudi children treated for infantile hemangioma

Background: Although the role of oral propranolol in treating IH is now well-recognized worldwide, the variation of treatment effectiveness over time and patients adherence have not been documented among Saudi. Objective: To identify the variation of effectiveness over the treatment period and the adherence to treatment of oral propranolol among Saudi children treated for infantile hemangiomas (IH). Patients and methods: Children presented for treatment of problematic IH between February 2012 and September 2015 were recruited in a prospective observational study of oral propranolol at 2 mg/kg/day. Data about patients’ adherence (categorized based compliance with the scheduled visits and treatment administration), lesion comparative response score (based on the relative improvement compared to previous visit) and possible side-effects were collected during follow-up. Treatment was stopped once the lesions failed to show significant improvement. Serial digital photography was used for response and final outcome assessments. Results: Thirty-six cases were enrolled at a median (range) age of 6 (2–55) months. Cases were classified as 19 minor and 17 major, including 10 with ulcerations. Adherence was poor in 12 (33.3%), moderate in 4 (11.1%) and good in 19 (52.8%). Excluding the poorly adherent, the mean duration of treatment and follow up were 6 ± 3.4 and 7 ± 4.6 months, respectively. A mean comparative response score of 1.67 from a maximum of 2 was achieved during the first month of treatment, then gradually diminished reaching 0.19 and 0 at 8 and 10 months respectively. Patients who successfully completed 6 months of treatment (n = 19) were more likely to present with major lesions (68.4% vs. 33.3%, P = 0.047) and at an earlier median age (4 vs. 11 months, P = 0.018). Complete or near complete responses was 47% achieved. All ulcerated lesions healed at a median of 2 (1–4) months. Conclusion: The most dramatic response to treatment appeared during the first month, then progressively diminished toward negligible benefits beyond 8 months. Adherence to treatment can pose a challenge to achieving satisfactory outcomes.