Bevacizumab for Epistaxis in Hereditary Hemorrhagic Telangiectasia: An Evidence-based Review

Ashleigh A. Halderman, Matthew W. Ryan, Bradley F. Marple, Raj Sindwani, Douglas D. Reh, David M. Poetker

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Epistaxis is a primary complaint in 90% to 96% of patients with hereditary hemorrhagic telangiectasia (HHT). Numerous surgical and medical treatments aim to decrease the frequency and severity of epistaxis in this patient population. Bevacizumab is a recombinant, humanized monoclonal antibody to vascular endothelial growth factor, an angiogenic factor elevated in HHT. It has been used in several forms to treat epistaxis in HHT but thus far, evidence-based recommendations are limited. Study Design: Systematic review with evidence-based recommendations. Methods: A systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using Embase, MEDLINE, MEDLINE In-Process/Epub, and Cochrane databases. English language abstracts were reviewed for relevance. Results: Eleven manuscripts met inclusion criteria and were analyzed. Submucosal injection, submucosal injection plus laser coagulation, intravenous (IV), and topical formulations of bevacizumab were evaluated for their therapeutic impact on epistaxis in patients with HHT. Three randomized controlled trials failed to show topical bevacizumab to be more effective in controlling epistaxis than saline or other moisturizers. Conclusions: The use of submucosal and IV bevacizumab shows promise, but further study is necessary to determine the true efficacy in the treatment of epistaxis as only grade C level exists currently. Based on the available literature, the use of topical bevacizumab is not recommended (grade B).

Original languageEnglish (US)
Pages (from-to)258-268
Number of pages11
JournalAmerican Journal of Rhinology and Allergy
Volume32
Issue number4
DOIs
StatePublished - Jul 1 2018

Fingerprint

Hereditary Hemorrhagic Telangiectasia
Epistaxis
MEDLINE
Laser Coagulation
Antibodies, Monoclonal, Humanized
Injections
Manuscripts
Angiogenesis Inducing Agents
Vascular Endothelial Growth Factor A
Meta-Analysis
Bevacizumab
Language
Randomized Controlled Trials
Databases
Guidelines
Therapeutics
Population

Keywords

  • bevacizumab
  • epistaxis
  • hereditary hemorrhagic telangiectasia
  • vascular endothelial growth factor

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Bevacizumab for Epistaxis in Hereditary Hemorrhagic Telangiectasia : An Evidence-based Review. / Halderman, Ashleigh A.; Ryan, Matthew W.; Marple, Bradley F.; Sindwani, Raj; Reh, Douglas D.; Poetker, David M.

In: American Journal of Rhinology and Allergy, Vol. 32, No. 4, 01.07.2018, p. 258-268.

Research output: Contribution to journalArticle

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