The Effect of Bevacizumab (Avastin) Treatment on Epistaxis in Hereditary Hemorrhagic Telangiectasia

Objectives/Hypothesis: Determine the effectiveness of treating epistaxis in hereditary hemorrhagic telangiectasia (HHT) with potassium titanyl phosphate (KTP) laser cautery combined with submucosal injection of 100 mg of bevacizumab. Study Design: Retrospective pilot study. Methods: Bevacizumab was injected throughout the nasal cavity following KTP laser treatment in 10 patients (bevacizumab/KTP group) and compared to nine patients previously treated with KTP laser alone (KTP group). Epistaxis frequency and severity, blood transfusion requirement, intravenous iron supplementation, emergency department visit frequency, and quality of life within 1 month and 1 year pre- and postsurgery were analyzed. Benefit was defined as less than three nosebleeds per week, with less than 10 minutes to stop each nosebleed, and no blood transfusions. The pre- and postsurgery data were analyzed within and between the two groups. Results: The groups were comparable in age and gender. Significant benefit was found in frequency of epistaxis (P < .05), number of blood transfusions (P = .04), disability (P = .01), and effect on social life (P = .03) 1 month pre- and postsurgery in the bevacizumab/KTP group. Eighty percent of bevacizumab/KTP group patients reported benefit in comparison to 56% in the KTP group. Conclusions: KTP laser combined with bevacizumab in HHT epistaxis is superior to KTP laser treatment alone. It significantly decreases frequency and severity of nosebleeds and blood transfusion requirements, and significantly improves work ability and quality of life.