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Oral propranolol in early stages of retinopathy of prematurity

  • Aldo Bancalari EMAIL logo , Ricardo Schade , Tomás Muñoz , Carolina Lazcano , Rodrigo Parada and Rubén Peña
Published/Copyright: February 4, 2016

Abstract

Objective: To assess the effect of oral propranolol on the progression of early stages of retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants.

Methods: We analyzed VLBW infants with ROP (stages 2–3, zones II-III). Newborns received oral propranolol (0.5 mg/kg/dose q8h), and were monitored throughout the treatment period for possible side effects. Propranolol was administered until regression of ROP. A historic control group of patients with equivalent ROP was used. We compared characteristics of both groups and the progression of retinopathy.

Results: Forty-seven newborns were included, 20 in the propranolol group and 27 in the control group. There were no significant differences in gestational age, birthweight or gender. The mean duration of treatment with propranolol was 58.2±17.6 days. Most patients started treatment with stage 2 disease (65.0%), and had zone III involvement (55.0%). In the treated group, 90.0% (18/20) of patients did not require intervention with laser or bevacizumab, compared to 51.8% in the control group (P<0.005). No cases of bradycardia, hypotension or hypoglycemia were observed.

Conclusions: Oral propranolol in early stages of ROP could prevent disease progression and reduce the need for invasive rescue therapy with laser or bevacizumab. No significant side effects were reported.


Corresponding author: Dr. Aldo Bancalari, San Martin 1436, Concepción, Chile 4070038, Tel.: 56-41-2722698, E-mail: ; and Neonatology Department, Guillermo Grant Benavente Hospital, Concepción, Biobio, Chile

  1. Funding: No additional funding, equipment or supplies were necessary.

References

[1] Raghuveer TS, Bloom BT. A paradigm shift in the prevention of retinopathy of prematurity. Neonatology 2011;100:116–29.10.1159/000322848Search in Google Scholar PubMed

[2] Bancalari A, González R, Vásquez C, Pradenas I. Retinopathy of prematurity: incidence and associated factors. Rev Chil Pediatr. 2000;71:114–21.10.4067/S0370-41062000000200006Search in Google Scholar

[3] Cavallaro G, Filippi L, Bagnoli P, La Marca G, Cristofori G, Raffaeli G, et al. The pathophysiology of retinopathy of prematurity: an update of previous and recent knowledge. Acta Ophthalmol. 2014;92:2–20.10.1111/aos.12049Search in Google Scholar PubMed

[4] Ristori C, Filippi L, Dal Monte M, Martini D, Cammalleri M, Fortunato P, et al. Role of the adrenergic system in a mouse model of oxygen-induced retinopathy: antiangiogenic effects of beta-adrenoreceptor blockade. Invest Ophthalmol Vis Sci. 2011;52:155–70.10.1167/iovs.10-5536Search in Google Scholar PubMed

[5] Lavine JA, Sang Y, Wang S, Ip MS, Sheibani N. Attenuation of choroidal neovascularization by β(2)-adrenoreceptor antagonism. JAMA Ophthalmol. 2013;13:376–82.10.1001/jamaophthalmol.2013.1476Search in Google Scholar PubMed PubMed Central

[6] Starkey E, Shahidullah H. Propranolol for infantile haemangiomas: a review. Arch Dis Child. 2011;96:890–3.10.1136/adc.2010.208884Search in Google Scholar PubMed

[7] Tang J, Li Z, Lu L, Cho CH. β-Adrenergic system, a backstage manipulator regulating tumour progression and drug target in cancer therapy. Semin Cancer Biol. 2013;23:533–42.10.1016/j.semcancer.2013.08.009Search in Google Scholar PubMed

[8] Ciccarelli M, Sorriento D, Cipolletta E, Santulli G, Fusco A, Zhou RH, et al. Impaired neoangiogenesis in β2-adrenoceptor gene-deficient mice: restoration by intravascular human β2-adrenoceptor gene transfer and role of NFkB and CREB transcription factors. Br J Pharmacol. 2011;162:712–21.10.1111/j.1476-5381.2010.01078.xSearch in Google Scholar PubMed PubMed Central

[9] Dal Monte M, Cammalleri M, Mattei E, Filippi L, Bagnoli P. Protective effects of β1/2 adrenergic receptor deletion in a model of oxygen-induced retinopathy. Invest Ophthalmol Vis Sci. 2014;56:59–73.10.1167/iovs.14-15263Search in Google Scholar PubMed

[10] Greenhouse JM, Szewczyk T. Skin hemangioma and retrolental fibroplasia. AMA Arch Derm. 1956;73:568–71.10.1001/archderm.1956.01550060038007Search in Google Scholar PubMed

[11] Praveen V, Vidavalur R, Rosenkrantz T, Hussain N. Infantile hemangiomas and retinopathy of prematurity: posible association. Pediatrics 2009;123:e484–9.10.1542/peds.2007-0803Search in Google Scholar PubMed

[12] Bancalari A, Schade R, Peña R, Pavez N. Intravitreal bevacizumab as single drug therapy for retinopathy of prematurity in 12 patients. Arch Argent Pediatr. 2014;112:160–3.Search in Google Scholar

[13] Good WV. Final results of the early treatment for retinopathy of prematurity (ETROP) randomized trial. Arch Ophthalmol. 2003;121:1684–94.10.1001/archopht.121.12.1684Search in Google Scholar PubMed

[14] Casini G, Dal Monte M, Fornaciari I, Filippi L, Bagnoli P. The β-adrenergic system as a possible new target for pharmacologic treatment of neovascular retinal diseases. Prog Retin Eye Res. 2014;42C:103–29.10.1016/j.preteyeres.2014.06.001Search in Google Scholar PubMed

[15] Bührer C, Bassler D. Oral propranolol: a new treatment for infants with retinopathy of prematurity? Neonatology 2015;108:49–52.10.1159/000381659Search in Google Scholar PubMed

[16] Martini D, Monte MD, Ristori C, Cupisti E, Mei S, Fiorini P, et al. Antiangiogenic effects of β2-adrenergic receptor blockade in a mouse model of oxygen-induced retinopathy. J Neurochem. 2011;119:1317–29.10.1111/j.1471-4159.2011.07530.xSearch in Google Scholar PubMed

[17] Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372:735–46.10.1056/NEJMoa1404710Search in Google Scholar PubMed

[18] Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009;26:610–4.10.1111/j.1525-1470.2009.00975.xSearch in Google Scholar PubMed

[19] Lamy S, Lachambre MP, Lord-Dufour S, Béliveau R. Propranolol suppresses angiogenesis in vitro: inhibition of proliferation, migration, and differentiation of endothelial cells. Vascul Pharmacol. 2010;53:200–8.10.1016/j.vph.2010.08.002Search in Google Scholar PubMed

[20] Filippi L, Cavallaro G, Bagnoli P, Dal Monte M, Fiorini P, Donzelli G, et al. Oral propranolol for retinopathy of prematurity: risks, safety concerns, and perspectives. J Pediatr. 2013;163:1570–7.10.1016/j.jpeds.2013.07.049Search in Google Scholar PubMed

[21] Makhoul IR, Peleg O, Miller B, Bar-Oz B, Kochavi O, Mechoulam H, et al. Oral propranolol versus placebo for retinopathy of prematurity: a pilot, randomised, double-blind prospective study. Arch Dis Child. 2013;98:565–7.10.1136/archdischild-2013-303951Search in Google Scholar PubMed

[22] International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–9.10.1001/archopht.123.7.991Search in Google Scholar

[23] Nuntnarumit P, Yang W, Bada-Ellzey HS. Blood pressure measurements in the newborn. Clin Perinatol. 1999;26:981–96.10.1016/S0095-5108(18)30030-7Search in Google Scholar

[24] Austeng D, Källen KB, Hellström A, Tornqvist K, Holmström GE. Natural history of retinopathy of prematurity in infants born before 27 weeks gestation in Sweden. Arch Ophthalmol. 2010;128:1289–94.10.1001/archophthalmol.2010.234Search in Google Scholar PubMed

[25] Chen YH, Lien RI, Tsai S, Chang CJ, Lai CC, Chao AN, et al. Natural history of retinopathy of prematurity: two-year outcomes of a prospective study. Retina 2015;35:141–8.10.1097/IAE.0000000000000270Search in Google Scholar PubMed

[26] Padrini L, Isacchi B, Bilia AR, Pini A, Lanzi C, Masini E, et al. Pharmacokinetics and local safety profile of propranolol eye drops in rabbits. Pediatr Res. 2014;76:378–85.10.1038/pr.2014.108Search in Google Scholar PubMed

  1. The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2015-10-22
Accepted: 2015-12-22
Published Online: 2016-2-4
Published in Print: 2016-7-1

©2016 by De Gruyter

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