Systemic bevacizumab for the treatment of chronic bleeding in hereditary haemorrhagic telangiectasia

Al‐Samkari, Hanny; Kritharis, Athena; Rodriguez-Lopez, Josanna; Kuter, David J.

doi:10.1111/joim.12832

Cited by 51 publications

(87 citation statements)

References 25 publications

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“…In total, 141 of 162 patients (87%) benefited from systemic IV bevacizumab treatment with reduced bleeding. Bleeding (epistaxis and/or GI bleeding) was the treatment indication in 106 patients (23,(26)(27)(28)(29)(30) , of whom 92 (87 %) had a positive effect of treatment with reduced bleeding, reduced transfusion needs, and/or increased levels of hemoglobin. Fifty-six patients from three studies (17,29,31) were primarily treated with systemic IV bevacizumab due to symptomatic hepatic involvement.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Thirty-four of these publications met all eligibility criteria and were included in the review, as were five abstracts with sufficient original data and our own unpublished dataset. The repeated search in September 2018 resulted in one extra case report (25) and one extra case series (26) . Characteristics of the eight case series (17,23,(26)(27)(28)(29)(30)(31) and the 33 case reports (25, included in the present study are summarized in Table 3 and Table 4, respectively, including study type, number of patients, gender,…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series

Rosenberg

Fialla

Kjeldsen

et al. 2019

Rhin

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Background: Hereditary Haemorrhagic Telangiectasia (HHT) is an autosomal dominant genetic disorder, with a wide variety of clinical manifestations due to the presence of multiple arteriovenous manifestations. Severe bleeding from the gastrointestinal (GI) tract and/or epistaxis presents a significant problem in a subgroup of patients and systemic bevacizumab, an angiogenesis inhibitor, has been suggested to benefit these patients. Objective:To perform a review of the literature concerning the efficacy of systemic bevacizumab in treatment of bleeding from the nose or GI tract in patients with HHT, including patients from our own HHT-center.Methods: A literature review was performed using the guideline "Preferred Reporting Items for systematic Reviews and Meta-Analysis statement" (PRISMA). Results:After careful selection, we finally analysed the results of eight case series and 33 case reports. Among 195 patients 171 (88%) had reduced bleeding after bevacizumab. Conclusions:Based on the literature review and data from our own case series, systemic bevacizumab is very promising as treatment for HHT patients with severe epistaxis and/or GI-bleeding. However, care should be taken using bevacizumab, a potent angiogenesis inhibitor; long-term side effects have not been studied in this population. A randomized controlled study is warranted to support the results in HHT patients.

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Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series

Rosenberg

Fialla

Kjeldsen

et al. 2019

Rhin

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“…[15][16][17][18][19] Systemic (intravenous) treatment with the anti-vascular endothelial growth factor monoclonal antibody bevacizumab has been shown to be effective in decreasing the frequency of hemorrhagic complications of HHT. 35,36 However, it has been challenging to demonstrate any significant decrease in frequency and severity of epistaxis. 37,38 Intranasal submucosal injection of bevacizumab has also been utilized, but has not been shown to be universally successful.…”

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confidence: 99%

Endovascular Treatment of Epistaxis

Wojak

2020

Semin intervent Radiol

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Epistaxis is not uncommon, with up to 60% of the population suffering from at least one episode in their lifetime and as many as 6% presenting for medical attention. An analysis of emergency room (ER) visits in the United States between 2009 and 2011 identified 1.2 million encounters for epistaxis, accounting for 0.32% of ER visits. Approximately 6% of patients will require more aggressive, invasive management in the form of transnasal ligation of the sphenopalatine artery or endovascular embolization. This article reviews the epidemiology, rationale for endovascular treatment, strategy for treatment, endovascular technique, postprocedural follow-up, and complications and their management.

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“…4 Subsequently, numerous clinical observations demonstrating marked reduction in HHT bleeding (epistaxis and digestive bleeding) following bevacizumab treatment have been published. [5][6][7][8][9][10] Notably, as highlighted by a simple search of PubMed for the terms bevacizumab and HHT, more than 70 publications are available since 2010 for this rare disease.…”

mentioning

confidence: 99%

Intravenous Bevacizumab in Hereditary Hemorrhagic Telangiectasia: A Role That Is Still to Be Defined

Dupuis‐Girod

2020

Mayo Clinic Proceedings

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Systemic bevacizumab for the treatment of chronic bleeding in hereditary haemorrhagic telangiectasia

Abstract: Systemic bevacizumab was highly effective to treat chronic bleeding in HHT. Further study is needed to confirm the magnitude of benefit and further define optimal dosing, treatment duration and long-term safety.

Cited by 51 publications

References 25 publications

Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series

Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series

Endovascular Treatment of Epistaxis

Intravenous Bevacizumab in Hereditary Hemorrhagic Telangiectasia: A Role That Is Still to Be Defined

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