Efficacy of intranasal Bevacizumab (Avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis.

OBJECTIVES/ HYPOTHESIS: Intranasal Bevacizumab is an effective therapy for epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT).

STUDY DESIGN: Retrospective chart review.

METHODS: In 32 successive patients presenting with recurrent HHT epistaxis 25-100 mg of Bevacizumab was applied intranasally either as a submucosal injection or as a topical spray between November 2008 and May 2010. In many of the injected patients, the Potassium Titanyl Phosphate (KTP) laser was used adjunctively for vessel photocoagulation. A phone interview was performed in July 2010 to assess for treatment efficacy.

RESULTS: All 32 treated patients were contacted with pre- and posttreatment epistaxis severity scores (ESS) compared. Seventeen patients received topical Bevacizumab, 10 patients received a submucosal injection, and 5 patients received both. In addition, 12 patients were also treated with the KTP laser at the time of their submucosal injection. In the pretreatment period the average ESS was 7.0 (SD = 2.1), whereas in the posttreatment group the average ESS was 2.9 (SD = 1.7). This represents a significant improvement in epistaxis severity (P < .0001).

CONCLUSIONS: In HHT patients intranasal Bevacizumab, applied as a topical spray or a submucosal injection, significantly improves epistaxis as measured by the Epistaxis Severity Score.