Low Dose of Bevacizumab Is Safe and Effective in Preventing Bleeding Episodes in Hereditary Hemorrhagic Telangiectasia

Lazaraki, Georgia; Akriviadis, Evangelos; Pilpilidis, Ioannis; Parisi, Ioanna; Tzilves, Dimitrios; Tarpangos, Anestis

doi:10.1038/ajg.2011.287

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…Many patients experienced cessation of the bleeding entirely following the intravenous (IV) bevacizumab. Table summarizes each of the included studies …”

Section: Resultsmentioning

confidence: 99%

Intravenous bevacizumab for complications of hereditary hemorrhagic telangiectasia: a review of the literature

Arizmendez

Rudmik

Poetker

2015

Int Forum Allergy Rhinol

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This is the first systematic review analyzing the data involving HHT patients treated with bevacizumab. The results show that patients treated with bevacizumab have global improvements as well as specific improvements in hemoglobin levels. Although all of the studies reported improvements, there are several limitations, including inconsistencies in outcome reporting. A large, randomized, controlled study is needed to further investigate hemorrhage and epistaxis outcomes in HHT patients treated with intravenous bevacizumab.

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“…Many patients experienced cessation of the bleeding entirely following the intravenous (IV) bevacizumab. Table summarizes each of the included studies …”

Section: Resultsmentioning

confidence: 99%

Intravenous bevacizumab for complications of hereditary hemorrhagic telangiectasia: a review of the literature

Arizmendez

Rudmik

Poetker

2015

Int Forum Allergy Rhinol

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“…In particular, the conventional (5-10 mg/kg) dose of intravenous bevacizumab that has been reported so far has not been applied to patients with gastrointestinal bleeding. In previous reports, at least 5 mg/kg intravenous bevacizumab was administered for initial and maintenance treatment [ 6 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Hereditary hemorrhagic telangiectasia treated with low dose intravenous bevacizumab

et al. 2014

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Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder that leads to mucocutaneous telangiectasias, epistaxis, and gastrointestinal bleeding. Depending on the severity and manifestation of the disease, various therapeutic modalities have been used, from local bleeding control to surgery or concomitant drug therapy. Several articles under review have presented guidelines for treatment of HHT with bevacizumab as a direct anti-angiogenesis strategy. Still, neither the exact optimal dose nor the minimum effective dose of intravenous bevacizumab in patients with severe HHT has been reported. A 55-year-old man presented with long-standing epistaxis, recent melena, dizziness, and a three-generation family history of chronic epistaxis, anemia, and regular blood transfusions. Treatment with argon plasma coagulation (APC) for the gastrointestinal bleeding failed to raise hemoglobin levels, we considered using the bevacizumab. We report a patient with severe HHT, who was treated with low-dose bevacizumab (2 mg/kg) and improved substantially.

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“…While several reports show a decrease of the severity and frequency of nosebleeds with low-dose bevacizumab (at doses of 1–2 mg/kg body weight applied every 2–3 weeks), rapid relapses are reported after cessation of anti-VEGF therapy without reporting about long-term follow-up [ 9 , 10 ]. The effectiveness of continued low-dose bevacizumab treatment (1 mg/kg body weight every 3 weeks) was demonstrated in an HHT patient who had initially been treated with bevacizumab at 5 mg/kg body weight and then relapsed [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Intermittent low-dose bevacizumab in hereditary hemorrhagic telangiectasia

Huemer

Dejaco

Grabmer

et al. 2016

Wien Klin Wochenschr

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SummaryBackgroundHereditary hemorrhagic telangiectasia is an inherited autosomal dominant disease presenting with recurrent bleeding episodes and iron deficiency anemia due to vascular malformations. Hereditary hemorrhagic telangiectasia is associated with an increased risk of stroke, gastrointestinal bleeding and pulmonary hypertension and life expectancy is significantly reduced. Excess vascular endothelial growth factor (VEGF) plays a key role in the pathophysiology of the disease.Case presentationHere we report about a male patient with hereditary hemorrhagic telangiectasia presenting with pulmonary and central nervous system involvement experiencing repetitive nosebleeds, necessitating frequent local cauterization and transfusion of more than 100 units of packed red blood cells. After initiation of temporary therapy with the anti-VEGF antibody bevacizumab at a dosage of 1 mg/kg body weight every 2 weeks, the nose bleeding episodes and the epistaxis severity score significantly decreased and long-lasting transfusion independence was achieved. Reinitiation of low-dose bevacizumab after relapse again proved effective without any documented therapy-related adverse events. In comparison to other reported anti-VEGF antibody protocols in hereditary hemorrhagic telangiectasia, our treatment approach proved to be cost-efficient.ConclusionIntermittent low-dose therapy with bevacizumab represents an effective and cost-efficient treatment option for transfusion-dependent patients with hereditary hemorrhagic telangiectasia.

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Low Dose of Bevacizumab Is Safe and Effective in Preventing Bleeding Episodes in Hereditary Hemorrhagic Telangiectasia

Cited by 15 publications

References 12 publications

Intravenous bevacizumab for complications of hereditary hemorrhagic telangiectasia: a review of the literature

Intravenous bevacizumab for complications of hereditary hemorrhagic telangiectasia: a review of the literature

Hereditary hemorrhagic telangiectasia treated with low dose intravenous bevacizumab

Intermittent low-dose bevacizumab in hereditary hemorrhagic telangiectasia

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