Topical application of timolol decreases the severity and frequency of epistaxis in patients who have previously undergone nasal dermoplasty for hereditary hemorrhagic telangiectasia

Ichimura, Keiichi; Kikuchi, Hisashi; Imayoshi, Shoichiro; Dias, Mari Shimada

doi:10.1016/j.anl.2015.12.001

Cited by 17 publications

(23 citation statements)

References 8 publications

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“…None of the secondary outcomes improved either. As observed in other studies in HHT 15,16 , epistaxis duration is highly variable from one patient to another and in a same patient over time, thus good responses to a treatment in case reports 13 or small series without a placebo group 17 need to be interpreted with caution.…”

Section: Discussionmentioning

confidence: 81%

Efficacy of TIMOLOL nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia. A double-blind, randomized, placebo-controlled trial

Dupuis‐Girod

Pitiot

Bergerot

et al. 2019

Sci Rep

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Hereditary hemorrhagic telangiectasia is a rare vascular genetic disease. Epistaxis is the most frequent and disabling manifestation, and timolol appears to be a new therapeutic option as non-selective beta-blockers have in vitro and in vivo anti-angiogenic properties. Our main objective was to evaluate the efficacy of TIMOLOL nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia. This study is a single-center, randomized, phase 2, double-blind placebo-controlled study with an allocation ratio of 1:1. It was proposed to patients with hereditary hemorrhagic telangiectasia monitored at the French Reference Center, and we included patients aged over 18 years, diagnosed with hereditary hemorrhagic telangiectasia and epistaxis. The treatment was self-administered by the patient with a posology of one spray (50 µL) of timolol 0.5% or placebo in each nostril twice a day for 28 consecutive days. The primary efficacy endpoint was mean monthly epistaxis duration, assessed by monitoring epistaxis grids. A total of 58 patients were randomized and treated. The baseline characteristics were similar in the 2 groups. Mean monthly epistaxis duration measured at 3 months was not significantly different in the 26 patients receiving the drug in comparison with the placebo group (p = 0.54). Toxicity was low and no severe adverse events were reported. One limitation is that we included all HHT patients with nosebleeds and did not take into account history of nasal surgery or nasal crusts. Timolol, administered by nasal spray at a dose of 0.25 mg in each nostril twice a day for 28 consecutive days, did not improve epistaxis in patients with hereditary hemorrhagic telangiectasia at 4 months after the beginning of the treatment.

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Section: Discussionmentioning

confidence: 81%

Efficacy of TIMOLOL nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia. A double-blind, randomized, placebo-controlled trial

Dupuis‐Girod

Pitiot

Bergerot

et al. 2019

Sci Rep

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“…Topical beta blockers were also introduced as part of the treatment for adult patients (Timolol 0.5% eye drop formulation). 8,9 Whilst the evidence for the use of Timolol eye drop amongst HHT patients is weak, the ongoing improvement reported by our patients has encouraged us to continue with this approach. Patients who were already on antihypertensive and experienced increasing epistaxis despite commencement and use of nasal emollients and topical beta blockers, were encouraged to switch their anti-hypertensive to systemic oral beta blockers (Propranolol 10-20 mg orally).…”

Section: Methodsmentioning

confidence: 89%

Improvement in epistaxis management: the experience of a dedicated hereditary haemorrhagic telangiectasia clinic

Anning

Huang

Ronan

et al. 2021

ANZ Journal of Surgery

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Background: Hereditary haemorrhagic telangiectasia (HHT) is a rare genetic vascular disorder which is characterised by the development of arteriovenous malformations and telangiectasias. A key clinical manifestation is recurrent epistaxis. This study examined the impact of a dedicated HHT clinic in a major Australian tertiary hospital on epistaxis symptoms and subjective quality of life. Methods: A multidisciplinary HHT clinic was established in 2015. All patients satisfied either genetic diagnosis or fulfilled Curacao criteria. A protocol based clinical assessment was performed and a standardised treatment regimen was implemented. Patients completed quality of life and epistaxis severity score (ESS) questionnaires at each review. Results: Participants of the dedicated clinic included 21 females (58.3%) and 15 males (41.7%), with a mean age of 49.0 AE 24.0 years. The ACVRL1 variant was the most common (n = 20, 55.6%). A statistically significant reduction in epistaxis severity was noted between the baseline and second review (P = 0.02) and was maintained to the third visit (P = 0.015). Patients older than 50 years demonstrate a consistently higher ESS than those less than 50 years old (P = 0.03). This trend is noted throughout the follow up period with the dedicated clinic. Conclusion:The introduction of a multidisciplinary, dedicated HHT clinic to provide enhanced assessment, monitored treatment regimen and greater access to care, resulted in improvement in the management of epistaxis and quality of life in these patients.

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“…Ichimura et al prospectively analysed the effect of topical timolol in 11 patients who had already undergone nasal dermoplasty. They found marked reduction in the intensity and frequency of bleeding [ 20 ]. In the current cohort, we did not use beta blockers, owing to the paucity of evidence on the subject at the time of treatment.…”

Section: Discussionmentioning

confidence: 99%

Long-term efficacy assessment of current treatment options for epistaxis in HHT

Dür

Anschuetz

Negoiaș

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder that presents with recurrent, intractable epistaxis. The aim of this study was to retrospectively analyze the efficacy of various treatment options for epistaxis in patients with HHT, over a period of 18 years, and to correlate these findings with available evidence in the literature. Methods Records of patients with HHT, treated for epistaxis between 2000 and 2018 were analyzed. Treatment procedures carried out and their efficacy were extracted and analyzed. Results Forty-three records were evaluated. All patients were given nasal humidifying ointments, 93% required acute treatment with bipolar electrocautery, and 60% underwent atraumatic nasal packing. Recurrent cases were treated medically with tranexamic acid (26%), oestrogen (19%), and bevacizumab (2%). Laser photocoagulation was done in selected cases (40%) and if unsuccessful, septal dermoplasty was performed (2.3%). Endovascular embolization was reserved for life-threatening emergencies (7%). Conclusion Epistaxis in HHT is not curable, but can be managed by employing a comprehensive stepwise approach. An algorithm for effective and comprehensive management has been presented.

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Topical application of timolol decreases the severity and frequency of epistaxis in patients who have previously undergone nasal dermoplasty for hereditary hemorrhagic telangiectasia

Cited by 17 publications

References 8 publications

Efficacy of TIMOLOL nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia. A double-blind, randomized, placebo-controlled trial

Efficacy of TIMOLOL nasal spray as a treatment for epistaxis in hereditary hemorrhagic telangiectasia. A double-blind, randomized, placebo-controlled trial

Improvement in epistaxis management: the experience of a dedicated hereditary haemorrhagic telangiectasia clinic

Long-term efficacy assessment of current treatment options for epistaxis in HHT

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