Long‐term experience with intranasal bevacizumab therapy

Steineger, Johan; Osnes, Terje; Heimdal, Ketil; Dheyauldeen, Sinan

doi:10.1002/lary.27147

Cited by 13 publications

(21 citation statements)

References 35 publications

(79 reference statements)

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“…The findings of this study confirmed our previous results that RISBI is an effective treatment for HHT‐associated epistaxis . The improvement in QoL after RISBI strengthens this conclusion by adding a new dimension to the effectiveness of this treatment.…”

Section: Discussionsupporting

confidence: 89%

“…The procedure is based on the vascular anatomy of the nose, and has been described in detail previously . Briefly, four intranasal sites are injected with 25 mg/ ml of bevacizumab on each side.…”

Section: Methodsmentioning

confidence: 99%

“…In a prior publication, we have described the effect of repeated intranasal submucosal bevacizumab injections (RISBI) on the long‐term frequency and intensity of HHT‐associated epistaxis …”

Section: Introductionmentioning

confidence: 99%

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Intranasal bevacizumab injections improve quality of life in HHT patients

et al. 2019

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Background: Epistaxis is the most common symptom in patients with hereditary hemorrhagic telangiectasia (HHT), with the greatest negative impact on quality of life (QoL). Repeated intranasal submucosal bevacizumab injections (RISBI) is a relatively new treatment option for moderate or severe grades of epistaxis in HHT. However, the effect of RISBI on QoL is not fully evaluated.Study Design: Prospective, non-comparative study. Materials and Methods: Patients treated by RISBI for HHT-associated epistaxis between June 2011 and August 2013 were prospectively invited to the present study. The end of follow-up was October 2013. The patients were requested to answer QoL questionnaires before the first treatment, and 6-8 weeks after the last treatment. Three levels of QoL were assessed: Overall QoL using Cantril's Self-Anchoring Ladder; Health-related QoL using Short Form 36 (SF-36), and Disease-specific QoL. Psychological distress was measured with the Hospital Anxiety and Depression scale (HADS).Results: Thirty-three patients were treated with RISBI during the period referred to above. Twenty-three patients completed the QoL questionnaires. The average number of treatments per patient was 2.15 AE 1.3 (Range: 1-5). The mean overall QoL improved from 6.47 AE 1.9 to 7.26 AE 1.6 (P < .05). Several dimensions measured by SF-36 were significantly improved with a medium to strong effect size. HADS demonstrated a significant decrease in psychological distress after the last treatment.Conclusion: HHT patients treated by RISBI improved in several aspects of quality of life, and psychological distress decreased. RISBI was an effective treatment option for moderate and severe grades of HHT-associated epistaxis.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

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Intranasal bevacizumab injections improve quality of life in HHT patients

et al. 2019

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“…12 The findings were supported by Sadick et al in 2005, who also reported elevated levels of VEGF in addition to TGF-β1 in 31 HHT patients. 13 Later on, VEGF inhibitors were shown to efficiently treat many HHT patients, 15,25 strengthening the assumption that VEGF is an important mediator in this disease. In our study, however, the higher levels of VEGF and TGF-β1 in the patient group were not statistically significant.…”

Section: E46mentioning

confidence: 99%

“…12,13 A monoclonal antibody that binds and inhibits VEGF, bevacizumab, has been applied in clinical practice in treating HHT patients. 14 However, some HHT patients have limited or no response to bevacizumab, [15][16][17] and the pathogenesis of this highly heterogeneous disorder is complex and not yet fully determined, most probably involving other mediators than VEGF and members of the TGF-β superfamily.…”

Section: Introductionmentioning

confidence: 99%

Pentraxin 3 level is elevated in hereditary hemorrhagic telangiectasia and reflects the severity of disease‐associated epistaxis

et al. 2018

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Objectives/Hypothesis We aimed to investigate if vascular endothelial growth factor (VEGF) and other angiogenic and inflammatory factors correlated with the clinical presentation in hereditary hemorrhagic telangiectasia (HHT) patients, particularly in regard to the severity of epistaxis. Study Design Prospective, comparative, single‐center study. Methods One hundred nine samples were collected from 75 HHT patients attending the ear, nose, and throat department at Oslo University Hospital from February 2012 to August 2013. For comparison, samples were collected from 16 healthy controls. Angiogenic and inflammatory factors related to endothelial cell activation were analyzed by enzyme immunoassays. The grade of epistaxis was evaluated using the Epistaxis Severity Score and epistaxis Intensity, Frequency, and Need for Blood Transfusion score at the day of blood sampling. The presence of internal organ manifestations in the HHT group was recorded. Results Pentraxin 3 (PTX3) was the only factor that was significantly higher in the HHT patients than the controls and showed significant correlation to the epistaxis severity grade and the hemoglobin level. The VEGF level was higher in the HHT patients compared to controls but not to a significant degree. In addition, a significant correlation of the level of VEGF and the grade of epistaxis could not be observed. Also, no significant correlations were observed between the presence of internal organ manifestations and the level of angiogenic factors. Conclusions PTX3, at least partly reflecting vascular inflammation, can be a potential biomarker for the severity of HHT associated epistaxis. The serum level of VEGF was not correlated with the severity of epistaxis in the HHT patients. Level of Evidence 2 Laryngoscope, 129:E44–E49, 2019

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Randomized, controlled, double‐blinded clinical trial of effect of bevacizumab injection in management of epistaxis in hereditary hemorrhagic telangiectasia patients undergoing surgical cauterization

Khanwalkar

Rathor

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et al. 2022

Int Forum Allergy Rhinol

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Background: Given its role in the disease pathophysiology, inhibition of vascular endothelial growth factor (VEGF)-mediated angiogenesis has received attention as a potential strategy to reduce epistaxis associated with hereditary hemorrhagic telangiectasia (HHT). In this study we evaluated the efficacy of a submucosal injection of bevacizumab, a VEGF inhibitor, in reducing the severity of epistaxis and improving quality of life when given at the time of operative electrocautery. Methods: This randomized, double-blinded, placebo-controlled trial was conducted at a single institution from 2014 to 2019. Patients scheduled to undergo operative bipolar electrocautery of nasal telangiectasias were randomized to receive a submucosal injection of saline or bevacizumab at time of surgery. Surveys to assess epistaxis severity and quality of life (QOL), including the Epistaxis Severity Score (ESS) and the 12-item Short Form (SF-12), were administered preoperatively and at 1, 2, 4, and 6 months postoperatively. The minimal clinically important difference (MCID) of the ESS instrument is reported to be 0.71. Results:Of 39 patients enrolled, 37 (94.9%) completed the study. The saline group demonstrated a reduced ESS vs baseline at 1 (−1.2; p = 0.01) and 4 (−1.2; p = 0.05) months postprocedure. The bevacizumab group demonstrated a reduced ESS score vs baseline at 1 (−2.3; p < 0.001), 2 (−2.3; p < 0.001), 4 (−2.0; p = 0.003), and 6 (−1.3; p = 0.05) months postprocedure. The additive benefit of bevacizumab over saline exceeded the MCID at 1, 2, and 4 months, but the difference was not statistically significant. Conclusion:The addition of a single treatment of submucosal bevacizumab may be associated with additional clinically meaningful benefit for up to 4 months when compared with electrocautery alone.

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Long‐term experience with intranasal bevacizumab therapy

Abstract: 4. Laryngoscope, 128:2237-2244, 2018.

Cited by 13 publications

References 35 publications

Intranasal bevacizumab injections improve quality of life in HHT patients

Intranasal bevacizumab injections improve quality of life in HHT patients

Pentraxin 3 level is elevated in hereditary hemorrhagic telangiectasia and reflects the severity of disease‐associated epistaxis

Randomized, controlled, double‐blinded clinical trial of effect of bevacizumab injection in management of epistaxis in hereditary hemorrhagic telangiectasia patients undergoing surgical cauterization

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