A recent study published in the American Journal of Ophthalmology compared the efficacy of propranolol in early treatment of retinopathy of prematurity (ROP).
Give me some background first.
As a multifaceted ocular condition, ROP is one of the most common avoidable causes of blindness in youth, particularly premature infants.
Typical signs include underdeveloped growth, oxygen-related complications, and inflammation—and can ultimately lead to retinal detachment.
Current interventions for ROP include laser photocoagulation and intravitreal anti-VEGF therapy, for which growing evidence suggests adverse side effects.
Which brings us to …
Propranolol, a non-selective beta-adrenergic receptor blocker, inhibits sympathetic excitement and catecholamine release, impacting angiogenesis. Recent studies have proposed it as an alternative therapeutic option for preterm newborns with ROP as well as an early preventative method for the disease.
Now, talk about the study.
Researchers conducted a meta-analysis to observe the effectiveness of propranolol on ROP by searching various databases, such as:
- PubMed
- Scopus
- Medline
- Google Scholar
- Science Direct
What studies were included in the study?
Out of an initial 3,646 papers, eight were identified for the final analysis. Each fulfilled the following inclusion criteria:
- Studied the effects of oral propranolol to protect preterm neonates from ROP
- Used randomized controlled trials (RCTs) or quasi-RCTs
- Studied outcome of treatments to prevent serious retinopathy in ROP patients
- Studies with control groups may use placebos or a group receiving a different treatment.
Findings?
The meta-analysis revealed that oral propranolol administration may be an effective way to reduce ROP and ROP progression compared to the control and other therapies, with an overall risk ratio of 0.59 (95% Cl 0.42, 0.82; P=0.002, 12=41%).
Tell me more.
Propranolol was also associated with a decreased risk of plus disease in ROP and a decreased risk of laser photocoagulation for ROP, relative to control groups.
Expert opinion?
Study authors stated that, “while propranolol’s efficacy is evident, its favorable attributes and strategic timing make it a compelling alternative to more invasive options.”
However, they noted that further research investigating propranolol in more diverse contexts would provide a greater understanding of its effects on ROP.
Anything else?
It has been suggested that propranolol administered at excessively high doses causes harmful side effects, but gradually increasing the dosage may not.
Limitations?
Most participants included in this study were of European descent, challenging the generalizability of the findings to other ethnic groups.
The safety of propranolol remains inconclusive as little is known about its adverse effects. To ensure the health of ROP patients, authors emphasized the need for extensive research regarding the effects of propranolol.
Take home.
This Research demonstrated that propranolol is associated with a lower risk of ROP progression and a decreased risk for requiring laser treatment.
Future studies investigating outcomes of propranolol on ROP in various contexts and the safety of propranolol will offer patients and eyecare professionals (ECPs) with greater awareness of propranolol as a treatment for ROP.