Timolol topico para Hemangiomas.

Timolol Maleate Safe and Effective for Infantile Hemangiomas

Pediatrics

BACKGROUND

There has been a dramatic increase in the off-label use of ophthalmic timolol maleate, a β-blocker used for infantile hemangioma (IH) treatment as a topical counterpart to oral propranolol. Its safety and efficacy in a pediatric population with IH have not been evaluated in a large cohort. Our goal was to retrospectively assess timolol's effectiveness, discern characteristics associated with response, and document reported adverse events.

METHODS

A multicenter retrospective cohort study of 731 patients treated with topical timolol was completed at 9 centers. Inclusion required an IH suitable for timolol in the treating physician's judgment and access to clinical details including photographs. Logistic regression analysis and descriptive statistics were performed. Primary outcome measures were efficacy assessed by using visual analog scales for color and for size, extent, and volume from review of digital photographs taken as standard of care.

RESULTS

Most IHs were localized (80.1%) and superficial (55.3%). Risk of disfigurement was the most common indication for therapy (74.3%). Duration of therapy (P < .0001), initial thinness (P = .008), and subtype (P = .031) were significant predictors of response. Best response occurred in superficial IHs <1 mm thick. Fifty-three (7.3%) required subsequent therapy with systemic β-blocker. Adverse events were mild, occurring in 25 (3.4%) patients. No cardiovascular side effects were documented.

CONCLUSIONS

Timolol seems to be a well-tolerated, safe treatment option with moderate to good effectiveness, demonstrating best response in thin, superficial IHs regardless of pretreatment size. Timolol can be recommended as an alternative to systemic β-blockers and watchful waiting for many patients.

• Article Citation

Pediatrics

Topical Timolol Maleate Treatment of Infantile Hemangiomas

Pediatrics 2016 Aug 15;[EPub Ahead of Print], K Püttgen, A Lucky, D Adams, E Pope, C McCuaig, J Powell, D Feigenbaum, Y Savva, E Baselga, K Holland, B Drolet, D Siegel, KD Morel, MC Garzon, E Mathes, C Lauren, A Nopper, K Horii, B Newell, W Song, I Frieden 

TAKE-HOME MESSAGE

• This international multicenter study was a retrospective analysis of the use of topical timolol in 731 patients with infantile hemangioma (IH). Over half of the IHs were superficial (55.3%) and the majority were localized (80.1%). Most (70%) of the patients were <6 months of age. Visual analog scales (VAS) were used to measure treatment response and the VAS for color showed a greater degree of improvement than for the VAS for size, extent, and volume. There was significantly improved treatment response with longer duration of topical timolol use. Other significant predictors of response included IH subtype and initial thinness. Adverse effects were evaluated and considered mild, most commonly involving local irritation such as scaling. There were no cardiovascular side effects.

• Topical timolol is a well-tolerated and effective treatment for thin (<1 mm thick), superficial infantile hemangiomas.

  – Sarah Churton, MD