Effectiveness of Propranolol in Preventing Severe Retinopathy of Prematurity: A Comprehensive Systematic Review and Meta-Analysis

• Published in: American journal of ophthalmology Vol. 259; pp. 141 - 150
• Main Authors: Shafique, Muhammad Ashir, Haseeb, Abdul, Uddin, Muhammad Musab Nafees, Asghar, Bushra, Chaudhry, Eymaan Riaz, Raqib, Moosa Abdur, Ali, Syed Muhammad Sinaan, Mustafa, Muhammad Saqlain
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2024
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Angiogenesis Inhibitors - therapeutic use; Humans; Infant, Newborn; Infant, Premature; Propranolol - therapeutic use; Retinopathy of Prematurity - diagnosis; Retinopathy of Prematurity - drug therapy; Retinopathy of Prematurity - prevention & control; Vascular Endothelial Growth Factor A
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2023.11.012

To learn more about the effectiveness of oral propranolol as a therapeutic alternative for preterm newborns with pre-existing retinopathy of prematurity (ROP) as well as an early prevention method for ROP, one of the most common but avoidable causes of juvenile blindness.
Meta-analysis of relevant literature.
A total of 3464 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, finally, a total of 8 studies were deemed suitable for review. Following the PRISMA guidelines, published literature was systematically assessed up to May 10, 2023. Trials and observational studies were included in which beta blockage was used to prevent severe ROP (defined as stage ≥3 or requiring treatment). A total of 3646 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, a total of 8 studies were deemed suitable for review.
The use of propranolol is linked to a lower risk of disease development in ROP compared to other therapies or control groups, according to the overall risk ratio of 0.59 (95% CI = 0.42, 0.82; P = .002, I2 = 41%). Additionally, the overall risk ratio for plus disease is 0.42 (95% CI = 0.23, 0.78; P = .006, I2 = 0%), for laser photocoagulation is 0.48 (95% CI = 0.31, 0.74; P = .001; I2 = 2%), and for intravitreal injection of VEGF is 0.43 (95% CI = 0.24, 0.74; P = 0.003, I2 = 0%), suggesting that use of propranolol may reduce the likelihood of developing a disease such as plus disease, requiring laser photocoagulation or necessitating intravitreal injection of vascular endothelial growth factor for ROP, respectively. No statistically significant heterogeneity was found in this study (P > .10, I2 = 50%). It can be concluded from this that the results of the chosen studies were sufficiently comparable and consistent.
This study showed that oral propranolol given as a preventive treatment in premature newborns successfully prevented severe ROP. Propranolol dosage and timing must now be carefully considered in the context of the study population, as these factors may have a major impact on the observed outcomes and treatment success.