Treatment of hereditary hemorrhagic telangiectasia with submucosal and topical bevacizumab therapy
Bevacizumab delivered as a submucosal and topical intranasal therapy effectively controls hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis. Prospective institutional review board-approved study. Between December 2009 and December 2010, 19 patients with HHT-associated epistaxis were treated with 100 mg of intranasal submucosal bevacizumab. Following treatment, patients were contacted monthly to report their epistaxis severity score (ESS) for 9 or more months after their initial treatment. If a patient had a significant increase in their ESS, they were offered treatment with 100 mg of topical bevacizumab, administered via a metered dose atomizer. All treatments were recorded. All 19 patients had a postinjection ESS documented through 9 months, whereas 17 patients had completed ESS data between months 10 and 12. Six of the 19 patients received eight additional 100 mg of topical bevacizumab treatments because they had an increase in their ESS. Results demonstrated a mean preinjection ESS of 8.12, with an ESS nadir of 2.00 reached at 2 months following submucosal injection (P < 0.0001). Over the following 12 months, the mean ESS steadily increased back to a maximum of 3.6 reached at 11 months following injection (P < .0001). Intranasal submucosal bevacizumab effectively treats HHT-associated epistaxis for up to 12 months following treatment.