Recombinant interferon alfa-2b in the treatment of vision-threatening capillary hemangiomas in childhood

doi:10.1016/S1091-8531(97)90042-2

Journal of American Association for Pediatric Ophthalmology and Strabismus

Volume 1, Issue 4, December 1997, Pages 226-230

https://doi.org/10.1016/S1091-8531(97)90042-2 Get rights and content

Abstract

Introduction: Hemangiomas of the orbit and eyelids may cause serious ocular problems usually related to amblyopia and astigmatism. Steroids have become the accepted treatment. However, some hemangiomas are resistant to steroids or require prolonged use, with unacceptable side effects. Interferon alfa-2b, an antiangiogenic protein, was used in this prospective study to treat visually threatening hemangiomas that were unresponsive to oral or intralesional steroid treatment. Methods: Forty patients aged 2 to 36 months with life- or organ-threatening hemangiomas were prospectively enrolled to evaluate the efficacy and safety of interferon alfa treatment for hemangiomas. Sixteen of these 40 patients had hemangiomas causing serious ocular dysfunction. The patients were treated with 3 × 10⁶ U/m² interferon alfa-2b subcutaneously daily for 3 months; treatment was then tapered or retreated according to response and protocol. Therapeutic responses were documented. Results: Fifteen patients with ocular hemangiomas have finished treatment. The pretreatment volume measured by computed axial tomography was an average of 22.3 cm³. Clinical response with eye opening was observed at an average of 6 weeks. There was a significant regression of the hemangioma in all patients, with an average 82% reduction in volume. Patients were treated with glasses and occlusion therapy as appropriate. Final visual acuities with a follow-up averaging 14 months after cessation of interferon treatment were normal, except that five of 15 patients had amblyopia; one of these patients had $2040$ , two had $2060$ , and two had $2070$ . There were no major illnesses or serious adverse side effects. Conclusion: Interferon alfa-2b treatment resulted in good to excellent regression of all the hemangiomas. This regression was clinically significant, with patients able to open the affected eye an average of 6 weeks into treatment. Visual results were good, with moderate amblyopia occurring only in patients treated at a later age. Interferon alfa-2b was well tolerated by these young patients, and no significant illness or side effect has occurred.

References (13)

BA Cohen
Hemangiomas in infancy and childhood
Pediatr Ann
(1987)
LE Bartoshesky et al.
Corticosteroid treatment of cutaneous hemangiomas: how effective?
Clin Pediatr
(1978)
CW White
Treatment of hemangiomatosis with recombinant interferon alfa
Semin Hematol
(1990)
J Folkman
Clinical applications of research on angiogenesis
N Engl J Med
(1995)
G Rosenthal et al.
Corticosteroid resistant orbital hemangioma with proptosis treated with interferon alfa-2a and partial tarsorrhaphy
J Pediatr Ophthalmol Strabismus
(1995)
M Loughnan et al.
Treatment of a massive orbital-capillary hemangioma with interferon alfa-2b: short term results
Arch Ophthalmol
(1992)

There are more references available in the full text version of this article.

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Citation Excerpt :
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Capillary hemangiomas of the eyelid and orbit are treated when amblyopia secondary to anisometropic astigmatism or pupillary occlusion is present or when rapid growth of the hemangioma threatens to occlude the pupil. The goal of this study was to determine whether treatment of hemangiomas resolves or prevents occlusion or results in decrease in astigmatism.
The records of 54 patients who underwent treatment for reduction in the size of a capillary hemangioma causing amblyopia or threatened amblyopia in two pediatric ophthalmology practices were reviewed.
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Treatment to reduce the size of capillary hemangiomas results in resolution of occlusion, reduction in astigmatism, and prevention of pupillary occlusion. Those with occlusion are at higher risk for severe residual amblyopia and require prompt and definitive treatment.
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The use of interferon alfa should, therefore, be limited to function-impairing or life-threatening hemangiomas. To this end, Hastings et al52 have reduced lesion size by 82% in 15 patients with orbital hemangiomas by using SQ interferon alfa-2b (3 × 106 U/m2/d for 3 months). Similarly, Ezekowitz et al46 noted regression of 50% or more in life- or vision-threatening hemangiomas that were resistant to corticosteroids in 18 of the 20 patients with interferon alfa-2a.
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration–approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.

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Major articleRecombinant interferon alfa-2b in the treatment of vision-threatening capillary hemangiomas in childhood☆

Abstract

Hemangiomas in infancy and childhood

Pediatr Ann

Corticosteroid treatment of cutaneous hemangiomas: how effective?

Clin Pediatr

Treatment of hemangiomatosis with recombinant interferon alfa

Semin Hematol

Clinical applications of research on angiogenesis

N Engl J Med

Corticosteroid resistant orbital hemangioma with proptosis treated with interferon alfa-2a and partial tarsorrhaphy

J Pediatr Ophthalmol Strabismus

Treatment of a massive orbital-capillary hemangioma with interferon alfa-2b: short term results

Arch Ophthalmol

Major article
Recombinant interferon alfa-2b in the treatment of vision-threatening capillary hemangiomas in childhood☆