Johan Steineger1, Terje Osnes1,2, Ketil Heimdal3,4, Sinan Dheyauldeen1. 1. Department of Otorhinolaryngology-Head and Neck Surgery. 2. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. 3. Division of Head and Neck and Reconstructive Surgery, Department of Medical Genetics. 4. Center for Rare Diagnosis, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Abstract
OBJECTIVES/HYPOTHESIS: Long-term follow-up of intranasal bevacizumab therapy in hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Prospective, noncomparative study. METHODS: Patients treated for HHT-associated epistaxis by intranasal submucosal bevacizumab injections between June 2011 and August 2013 were included and followed prospectively. The effectiveness of the treatment was evaluated by the epistaxis severity score (ESS); the epistaxis intensity, frequency, and the need of blood transfusion (IFT) score; and hemoglobin levels. RESULTS: Thirty-three patients were included. The total number of treatments with intranasal bevacizumab injection was 210. The mean number of treatments per patient was 6.2 ± 4.6 (range, 1-16), and the mean treatment and observation period was 38.8 ± 21.8 months (range, 2-66 months). Four patients showed no improvement after treatment. Eleven patients (33.3%) showed initial improvement in both ESS and IFT, but the treatment was discontinued before the end of the study because the effect became gradually shorter lasting despite repeated injections. Twelve patients (36.3%) continued to have a positive response to the treatment at the end of the study. No local adverse effects were observed, but one patient developed osteonecrosis in both knees during the treatment period. CONCLUSIONS: Intranasal bevacizumab injection is an effective treatment for most of the moderate and severe grades of HHT-associated epistaxis. The duration of the effect of the treatment was variable. Primary and late resistance phenomena to the treatment were quite common. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2237-2244, 2018.
OBJECTIVES/HYPOTHESIS: Long-term follow-up of intranasal bevacizumab therapy in hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Prospective, noncomparative study. METHODS:Patients treated for HHT-associated epistaxis by intranasal submucosal bevacizumab injections between June 2011 and August 2013 were included and followed prospectively. The effectiveness of the treatment was evaluated by the epistaxis severity score (ESS); the epistaxis intensity, frequency, and the need of blood transfusion (IFT) score; and hemoglobin levels. RESULTS: Thirty-three patients were included. The total number of treatments with intranasal bevacizumab injection was 210. The mean number of treatments per patient was 6.2 ± 4.6 (range, 1-16), and the mean treatment and observation period was 38.8 ± 21.8 months (range, 2-66 months). Four patients showed no improvement after treatment. Eleven patients (33.3%) showed initial improvement in both ESS and IFT, but the treatment was discontinued before the end of the study because the effect became gradually shorter lasting despite repeated injections. Twelve patients (36.3%) continued to have a positive response to the treatment at the end of the study. No local adverse effects were observed, but one patient developed osteonecrosis in both knees during the treatment period. CONCLUSIONS: Intranasal bevacizumab injection is an effective treatment for most of the moderate and severe grades of HHT-associated epistaxis. The duration of the effect of the treatment was variable. Primary and late resistance phenomena to the treatment were quite common. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:2237-2244, 2018.
Authors: Mehmet Baysal; Elif G. Ümit; Hakkı Onur Kırkızlar; Ali Caner Özdöver; Ahmet Muzaffer Demir Journal: Turk J Haematol Date: 2018-06-08 Impact factor: 1.831
Authors: Cilgia Dür; L Anschuetz; S Negoias; O C Bulut; A Angelillo-Scherrer; M Caversaccio Journal: Eur Arch Otorhinolaryngol Date: 2021-03-04 Impact factor: 2.503