title: Pharmacologic Interventions for Infantile Hemangioma: A Meta-analysis.
abstract: BACKGROUND
  Infantile hemangiomas (IH) may be associated with significant functional impact.
  
  
  OBJECTIVE
  The objective of this study was to meta-analyze studies of pharmacologic interventions for children with IH.
  
  
  METHODS
  Data sources were Medline and other databases from 1982 to June 2015.
  
  
  METHODS
  Two reviewers assessed studies using predetermined inclusion criteria.
  
  
  METHODS
  One reviewer extracted data with review by a second.
  
  
  RESULTS
  We included 18 studies in a network meta-analysis assessing relative expected rates of IH clearance associated with β-blockers and steroids. Oral propranolol had the largest mean estimate of expected clearance (95%; 95% Bayesian credible interval [BCI]: 88%-99%) relative to oral corticosteroids (43%, 95% BCI: 21%-66%) and control (6%, 95% BCI: 1%-11%). Strength of evidence (SOE) was high for propranolol's effects on reducing lesion size compared with observation/placebo. Corticosteroids demonstrated moderate effectiveness at reducing size/volume (moderate SOE for improvement in IH). SOE was low for effects of topical timolol versus placebo.
  
  
  CONCLUSIONS
  Methodologic limitations of available evidence may compromise SOE. Validity of meta-analytic estimates relies on the assumption of exchangeability among studies, conditional on effects of the intervention. Results rely on assumed lack of reporting bias.
  
  
  CONCLUSIONS
  Propranolol is effective at reducing IH size compared with placebo, observation, and other treatments including steroids in most studies. Corticosteroids demonstrate moderate effectiveness at reducing IH size/volume. The meta-analysis estimates provide a relative ranking of anticipated rates of lesion clearance among treatments. Families and clinicians making treatment decisions should also factor in elements such as lesion size, location, number, and type, and patient and family preferences.
authors.affiliation: Departments of Otolaryngology, sivakumar.chinnadurai@vanderbilt.edu.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Chinnadurai
authors.affiliation: Biostatistics.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fonnesbeck
authors.affiliation: Division of Pediatric Hematology/Oncology, Helen DeVos Children's Hospital, Grand Rapids, Michigan; and Division of Pediatric Hematology/Oncology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Snyder
authors.affiliation: Health Policy, and Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Nila A
authors.initials: NA
authors.lastname: Sathe
authors.affiliation: Pediatrics, and.
authors.forename: Anna
authors.initials: A
authors.lastname: Morad
authors.affiliation: Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt University School of Nursing, Nashville, Tennessee.
authors.forename: Frances E
authors.initials: FE
authors.lastname: Likis
authors.affiliation: Health Policy, and Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McPheeters
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011433:Propranolol / Q000627:therapeutic use; D013999:Timolol / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D005938:Glucocorticoids; D013999:Timolol; D011433:Propranolol