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Pottier C, Guichard E, Thomann C, Denevault-Sabourin C, Maruani A, Leducq S. Knowledge of community pharmacists on infantile haemangioma: Gaps and lack confidence to deliver propranolol still need to be filled. Acta Paediatr 2024; 113:1017-1023. [PMID: 38287483 DOI: 10.1111/apa.17128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/31/2024]
Abstract
AIM To evaluate the knowledge, practices and self-confidence of community pharmacists, pharmacy technicians and pharmacy students about infantile haemangioma (IH) and propranolol treatment. METHODS A national survey was conducted in France from May 2022 to October 2022. A 42-item online questionnaire was used to assess pharmacists' knowledge of the epidemiology, clinical features and management of IH and propranolol treatment. RESULTS The survey included 255 participants. The mean age was 34.9 years (±9.0); 225 (88%) were women. In all, 193 (76%) practised in urban pharmacies. Altogether, 83 participants (33%) had delivered oral propranolol solution for IH in the last 6 months. Participants' median score for self-confidence regarding propranolol dispensing was five (interquartile range, 2.5-6) on a scale of 1 to 10. Overall, 96 (38%) had more than 50% correct answers on the questionnaire. Multinomial regression models showed high scores on the questionnaire associated with high self-confidence when delivering oral propranolol solution, low number of years since graduation and having already delivered propranolol treatment. CONCLUSION This study highlights a lack of knowledge of IH and modalities of propranolol treatment by community pharmacists and slight self-confidence when delivering propranolol. Greater cooperation between healthcare professionals could improve the proper use of medicine.
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Affiliation(s)
| | - Elie Guichard
- CHRU Tours, Clinical Investigation Center- INSERM 1415, Tours, France
| | - Claire Thomann
- Pharmacy Department, Tours University Hospital, Tours, France
| | - Caroline Denevault-Sabourin
- Faculty of Pharmacy, University of Tours, Tours, France
- Team "Proteolytic Mechanisms in Inflammation", INSERM, UMR1100, Research Center for Respiratory Diseases (CEPR), Tours, France
| | - Annabel Maruani
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Tours, France
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France
| | - Sophie Leducq
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Tours, France
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2
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Mauguen C, Maruani A, Barbarot S, Abasq C, Martin L, Herbert J, Goronflot T, Gourraud PA, Happe A, Descatha A, Chrétien JM, Beuchée A, Adamski H, Dupuy A, Bouzillé G, Oger E, Droitcourt C. Factors associated with early relapse of infantile haemangioma in children treated for at least six months with oral propranolol: A case-control study using the 2014-2021 French Ouest DataHub. Ann Dermatol Venereol 2023; 150:189-194. [PMID: 37225615 DOI: 10.1016/j.annder.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/08/2022] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The factors associated with early relapse of infantile haemangioma (IH) after a first course of treatment with oral propranolol for at least six months (initiated after the marketing authorization had been granted) have not previously been investigated. OBJECTIVES To identify factors associated with the risk of early relapse in children with IH treated with oral propranolol according to the current prescribing guidelines. METHODS We performed a multicentre, retrospective, case-control study, using the Ouest Data Hub database. All children treated for at least 6 months with oral propranolol for IH between 31 June 2014 and 31 December 2021, and with a follow-up visit at least three months after treatment discontinuation were included. A case was defined as relapse of IH within three months of treatment discontinuation; each case was matched for age at treatment initiation and for centre, with four (relapse-free) controls. The association between relapse and treatment or IH characteristics was expressed as an odds ratio (OR) from univariate and multivariate conditional logistic regressions. RESULTS A total of 225 children were included. Of these, 36 (16%) relapsed early. In a multivariate analysis, a deep IH component was a risk factor for early relapse [OR = 8.93; 95%CI: 1.0-78.9, p = 0.05]. A propranolol dosage level of less than 3 mg/kg/day protected against early relapse [OR = 0.11; 95%CI: 0.02-0.7, p = 0.02]. Tapering before propranolol discontinuation was not associated with a lower risk of early relapse. CONCLUSION The risk factors for late and early relapse are probably different. Investigation of the risk factors for early vs. late IH relapse is now warranted.
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Affiliation(s)
- C Mauguen
- Department of Dermatology, CHU Rennes, 35000 Rennes, France.
| | - A Maruani
- University of Tours, INSERM 1246-SPHERE, Department of Dermatology, Tours University Hospital, F-37000 Tours, France; Dermatology Department and Reference Centre for Rare Diseases and Vascular Malformations (MAGEC), Tours University Hospital, 37000 Tours, France
| | - S Barbarot
- Department of Dermatology, CHU Nantes and INSERM CIC 004, 44000 Nantes, France
| | - C Abasq
- Department of Dermatology, Brest University Hospital, 29200 Brest, France
| | - L Martin
- Department of Dermatology, Angers University Hospital, 4, rue Larrey, 49933 Angers, France
| | - J Herbert
- Clinical Data Centre, Public Health and Prevention Unit, Tours University Hospital, 37044 Tours, France
| | - T Goronflot
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, 44000 Nantes, France
| | - P-A Gourraud
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, 44000 Nantes, France
| | - A Happe
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - A Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 49000 Angers, France
| | - J-M Chrétien
- Clinical Research Department, Angers University Hospital, 49000 Angers, France
| | - A Beuchée
- Department of Neonatalogy, Rennes University Hospital, Rennes, France
| | - H Adamski
- Department of Dermatology, CHU Rennes, 35000 Rennes, France
| | - A Dupuy
- Department of Dermatology, CHU Rennes, 35000 Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - G Bouzillé
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - E Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, 35000 Rennes, France
| | - C Droitcourt
- Department of Dermatology, CHU Rennes, 35000 Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
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3
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Yang E, Wang X, Huang S, Li M, Li Y, Geng Y, Liu X, Chen Z, Zhang D, Wu H. Shikonin reverses pyruvate kinase isoform M2-mediated propranolol resistance in infantile hemangioma through reactive oxygen species-induced autophagic dysfunction. Cancer Sci 2023; 114:806-821. [PMID: 36369903 PMCID: PMC9986094 DOI: 10.1111/cas.15649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Abstract
Infantile hemangioma (IH) is the most common benign tumor in infancy. Propranolol, a nonselective β-adrenergic receptor blocker, is now the first-line therapy for IH. Recently, low sensitivity to propranolol therapy has become one major reason for the failure of IH treatment. However, the exact underlying mechanisms are yet to be fully elucidated. Here, we reported that pyruvate kinase isoform M2 (PKM2), an essential glycolytic enzyme, played a critical role in regulating the progression of IH and the therapeutic resistance of propranolol treatment. Shikonin reversed the propranolol resistance in hemangioma-derived endothelial cells and in hemangioma animal models. Moreover, shikonin combined with propranolol could induce excessive reactive oxygen species (ROS) accumulation and lead to autophagic dysfunction, which is essential for the enhanced therapeutic sensitivity of propranolol treatment. Taken together, our results indicated that PKM2 has a significant role in hemangiomas progression and therapeutic resistance; it could be a safe and effective therapeutic strategy for those hemangiomas with poor propranolol sensitivity combined with shikonin.
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Affiliation(s)
- Enli Yang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuan Wang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shengyun Huang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingyang Li
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yiming Li
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yiming Geng
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuejian Liu
- Department of Hemangioma, Shandong Provincial Third Hospital, Jinan, China
| | - Zhanwei Chen
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dongsheng Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haiwei Wu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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4
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Börjesson C, Malloizel-Delaunay J, Onnis G, Mazereeuw-Hautier J, Dreyfus I. Value of Doppler ultrasound scans in deciding whether to treat infantile haemangioma with oral propranolol. Ann Dermatol Venereol 2021; 148:233-237. [PMID: 34218938 DOI: 10.1016/j.annder.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/04/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oral propranolol (Pr) must be administered until the end of the proliferation phase of infantile haemangioma (IH). This phase may be difficult to assess, particularly where a deep component is involved. Doppler ultrasound scans (DUS), which identify vascular activity (VA), could assist the clinician in making the correct therapeutic decision (CTD). PATIENTS AND METHODS All children with IH treated with Pr for at least 3 months and up to the age of 9 months, and who also underwent DUS, were enrolled in this retrospective, single-centre, observational study. The quality of DUS as a binary diagnostic test for IH proliferation was assessed, together with its value in deciding whether to discontinue Pr (at the end of the presumed proliferation phase) or resume this drug (in the case of suspected recurrence). RESULTS A total of 29 children were enrolled and 45 DUS were performed. Thirty-nine (87%) DUS were of high quality (80% sensitivity, 95% specificity) and made a major, moderate, or minimal contribution to the CTD in respectively 20%, 60% and 7% of cases. DISCUSSION DUS proved to be a high-value tool. They were essential in some cases of IH, mainly periocular and localised forms, and those involving deep components, in which the question of discontinuing Pr arose (age>1 year) and where clinical examination had not been sufficient to make the CTD. Furthermore, in the vast majority of cases, they provide a helpful examination and complement clinical findings in terms of patient follow-up and reaching a CTD. CONCLUSION DUS is an effective and complementary tool to clinical investigation.
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Affiliation(s)
- C Börjesson
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France.
| | - J Malloizel-Delaunay
- Department of Vascular Medicine, University Hospital of Toulouse, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
| | - G Onnis
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France
| | - J Mazereeuw-Hautier
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France
| | - I Dreyfus
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France
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5
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Frieden IJ, Püttgen KB, Drolet BA, Garzon MC, Chamlin SL, Pope E, Mancini AJ, Lauren CT, Mathes EF, Siegel DH, Gupta D, Haggstrom AN, Tollefson MM, Baselga E, Morel KD, Shah SD, Holland KE, Adams DM, Horii KA, Newell BD, Powell J, McCuaig CC, Nopper AJ, Metry DW, Maguiness S. Management of infantile hemangiomas during the COVID pandemic. Pediatr Dermatol 2020; 37:412-418. [PMID: 32298480 PMCID: PMC7262142 DOI: 10.1111/pde.14196] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long-term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA-approved monitoring guidelines, clinical practice guidelines, and relevant, up-to-date publications regarding initiation and monitoring of beta-blocker therapy were used to inform the recommendations. Clinical decision-making guidelines about when telehealth is an appropriate alternative to in-office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided.
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Affiliation(s)
- Ilona J Frieden
- University of California San Francisco, San Francisco, California, USA
| | | | - Beth A Drolet
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Maria C Garzon
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarah L Chamlin
- Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elena Pope
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anthony J Mancini
- Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christine T Lauren
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Erin F Mathes
- University of California San Francisco, San Francisco, California, USA
| | - Dawn H Siegel
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Deepti Gupta
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | | | - Kimberly D Morel
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sonal D Shah
- University of California San Francisco, San Francisco, California, USA
| | | | | | - Kimberly A Horii
- University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Brandon D Newell
- University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Catherine C McCuaig
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Amy J Nopper
- University of Missouri - Kansas City, Kansas City, Missouri, USA
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