Timolol 2.5mg/ml eye drops preservative free

Background Propranolol, a nonselective β-blocker, is the first-line treatment for infantile hemangioma (IH). Topical timolol has recently been proposed as a novel IH treatment with fewer adverse effects. This study was conducted to compare the efficacy and safety of oral propranolol and topical timolol for treating IH. Methods Studies were included after searching PubMed, Embase, Web of Science, and the Cochrane Library via the keywords of “propranolol”, “timolol”, “infantile hemangioma” and their synonyms. A meta-analysis with pooled odds ratios was performed using the fixed-effect model. Results Seven articles with 2071 patients were included in this meta-analysis. Compared with topical timolol, oral propranolol had a greater response rate (OR = 2.12, P < 0.001), but it was also associated with a greater risk of adverse events (OR = 2.31, P < 0.001). For superficial IH, timolol demonstrated similar efficacy to propranolol (OR = 1.28, P = 0.34) but with fewer adverse events (OR = 2.30, P = 0.001). Additionally, compared with topical timolol, propranolol at a dosage of 2 mg/kg/d had a better response rate (OR = 2.62, P < 0.001), whereas the 1.0∼1.5 mg/kg/d propranolol group showed no significant difference (OR = 1.34, P = 0.38). Conclusion Oral propranolol presents superior therapeutic efficacy in the treatment of IH compared to topical timolol. However, topical timolol can serve as an alternative to oral propranolol for treating superficial IH, providing similar efficacy with fewer adverse effects. Additionally, propranolol at a dosage of 2 mg/kg/d offers greater efficacy with a comparable safety profile, whereas the 1.0∼1.5 mg/kg/d propranolol dosage shows no significant difference in efficacy compared to timolol but is associated with more adverse events. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024603724, identifier CRD42024603724.

Abstract licence: CC BY

ObjectiveThis 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.MethodsA 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.ResultsEight 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.ConclusionPropranolol 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.

Abstract licence: CC BY