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.