Efficacy and safety of atenolol versus propranolol for treatment of infantile haemangioma: A narrative review

Infantile haemangiomas (IH) remain the most common benign vascular tumours in childhood. While most IH can be managed conservatively, a proportion of these lesions can cause disfigurement, ulceration or functional impairment, requiring prompt intervention. Propranolol, a lipophilic non-selective beta blocker, has been regarded as first-line therapy, following a serendipitous discovery of its use for IH in 2008. While efficacious, it has been associated with adverse effects such as hypoglycaemia, bronchospasm, sleep disturbances and agitation in infant trials. Hence, atenolol, a hydrophilic beta-1 selective blocker, has demonstrated similar efficacy and potentially greater tolerability, being less likely to cause sleep disturbances given its inability to cross the blood brain barrier, and a decrease in bronchial reactivity. The purpose of this review is to explore and critique the current knowledge on the efficacy and safety of propranolol against atenolol in children with IH. A total of seven studies comparing the two beta-blockers were identified in our search. Atenolol appeared to be as efficacious as propranolol and was associated with fewer central nervous system and bronchial-related adverse events. Further research exploring the optimal dosing for atenolol, particularly for ulcerated or syndromic IH, as well as incidence and management of rebound growth would be beneficial.