Bevacizumab : un nouveau succès dans la maladie de Rendu-Osler

Management of Refractory Gastrointestinal Bleeding in Hereditary Hemorrhagic Telangiectasia with Bevacizumab

“…Data regarding the efficacy of Bev in GI bleeding have been limited yet promising. Recent studies have reported that the use of Bev in GI bleeding has led to significantly reduced RBC transfusion requirements, increased mean hemoglobin levels, and reduced GI procedures [ 9 , 12 – 14 ]. A multicenter study, the inHIBIT-Bleed study, of 238 patients noted that one year of treatment with Bev resulted in an increase in mean hemoglobin by 3.2 g/dl, decrease in RBC units transfused by 82%, and decrease in iron infusions by 70% [ 24 ].…”

“…Bevacizumab (Bev) is a recombinant monoclonal antibody that inhibits VEGF [ 9 ]. Bev is emerging as an efficacious treatment for recurrent GI bleeding in patients with HHT [ 5 , 9 – 14 ]. We present a case of a 67-year-old Caucasian female with a history of HHT, GI AVMs, and multiple admissions for recurrent GI bleeding who failed conventional therapy and had an excellent clinical response to Bev infusions.…”

High-Output Heart Failure Contributing to Recurrent Epistaxis Kiesselbach Area Syndrome in a Patient With Hereditary Hemorrhagic Telangiectasia

“…Studies have found it to be safe to use in HHT, but it is not currently approved by the Food and Drug Administration in the treatment of epistaxis in HHT until more studies are suggestive of actual benefit of a decrease in epistaxis. 30 - 33 Thalidomide, a platelet derived growth factor B stimulator, is another drug proposed to treat epistaxis and gastrointestinal bleeding in HHT. 34 , 35 However, thalidomide has a significant side effect profile of increased fatigue and neuropathy, and both bevacizumab and thalidomide’s efficacy are not established with Phase 2 clinical trials.…”

“… 34 , 35 However, thalidomide has a significant side effect profile of increased fatigue and neuropathy, and both bevacizumab and thalidomide’s efficacy are not established with Phase 2 clinical trials. 29 - 34 Hence, we propose that REKAS in HHT can be avoided with correction of the reversible causes of high-output heart failure by correcting the anemia through increasing hemoglobin level to approximately greater than 9 to 10 g/dL.…”