A Systematic Review and Meta-Analysis of the Efficacy and Safety of Propranolol Versus Other Drugs in the Treatment of Infantile Hemangioma.
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OBJECTIVE: This study aimed to systematically evaluate and compare the efficacy and safety of propranolol versus atenolol, corticosteroids, timolol, and other therapies in the treatment of infantile hemangioma (IH) through a meta-analysis, thereby providing evidence-based guidance for clinical practice. METHODS: A comprehensive literature search was conducted across PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, and Wanfang databases from inception to December 2025. The protocol was prospectively registered with PROSPERO (CRD420261294316). Randomized controlled trials (RCTs) or clinical controlled trials (CCTs) comparing oral propranolol with other active drugs in IH patients aged ≤ 12 years were included. Primary outcomes were overall response rate (≥ 50% reduction), complete remission rate, and incidence of adverse events. Two reviewers independently performed study selection, data extraction, and quality assessment using the Cochrane RoB 2.0 tool and Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using R software. Heterogeneity was assessed using the I2 statistic. RESULTS: Eight studies involving 900 patients (propranolol: 464; control: 436) were included. Meta-analysis revealed no statistically significant difference in overall response rate between propranolol and control groups (pooled OR = 1.29, 95% CI: 0.80-2.09, p = 0.30). However, propranolol demonstrated a significantly higher complete remission rate (OR = 1.35, 95% CI: 1.01-1.82, p = 0.045). Subgroup analyses by control drug type (atenolol, corticosteroids, timolol, combination therapy) showed no significant differences in efficacy (all p > 0.05). Safety analysis indicated no significant difference in adverse event incidence between groups (OR = 0.76, 95% CI: 0.38-1.55, p = 0.45), albeit with moderate heterogeneity (I2 = 56%). Heterogeneity was low for efficacy outcomes (I2 = 0%). Funnel plot symmetry and a non-significant Egger's test suggested a low risk of publication bias. CONCLUSION: Propranolol offers a statistically significant advantage in achieving complete remission of infantile hemangioma compared to other active agents, while maintaining comparable overall response rates and a similar overall safety profile. These findings support propranolol as a first-line therapy when complete lesion resolution is the primary goal. Atenolol represents an effective alternative, particularly for patients with specific tolerability concerns, underscoring the need for individualized treatment selection.