Does severe bleeding in HHT patients respond to intravenous bevacizumab?

Review of the literature and case series

T Rosenberg, A D Fialla, J Kjeldsen, A D Kjeldsen*

*Corresponding author for this work

Research output: Contribution to journalReviewResearchpeer-review

Abstract

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 MetaAnalysis 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.

Original languageEnglish
JournalRhinology
Volume57
Issue number4
Pages (from-to)242-251
ISSN0300-0729
DOIs
Publication statusPublished - 1. Aug 2019

Fingerprint

Epistaxis
Angiogenesis Inhibitors
Gastrointestinal Tract
Bevacizumab
Nose
Guidelines
Population

Keywords

  • Bevacizumab
  • Epistaxis
  • GI-bleeding
  • HHT
  • Hereditary haemorrhagic telangiectasia

Cite this

@article{d1a0da47337d45e6b8197f735ab13ee2,
title = "Does severe bleeding in HHT patients respond to intravenous bevacizumab?: Review of the literature and case series",
abstract = "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 MetaAnalysis 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.",
keywords = "Bevacizumab, Epistaxis, GI-bleeding, HHT, Hereditary haemorrhagic telangiectasia",
author = "T Rosenberg and Fialla, {A D} and J Kjeldsen and Kjeldsen, {A D}",
year = "2019",
month = "8",
day = "1",
doi = "10.4193/Rhin18.289",
language = "English",
volume = "57",
pages = "242--251",
journal = "Rhinology",
issn = "0300-0729",
publisher = "International Rhinologic Society",
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}

Does severe bleeding in HHT patients respond to intravenous bevacizumab? Review of the literature and case series. / Rosenberg, T; Fialla, A D; Kjeldsen, J; Kjeldsen, A D.

In: Rhinology, Vol. 57, No. 4, 01.08.2019, p. 242-251.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - Does severe bleeding in HHT patients respond to intravenous bevacizumab?

T2 - Review of the literature and case series

AU - Rosenberg, T

AU - Fialla, A D

AU - Kjeldsen, J

AU - Kjeldsen, A D

PY - 2019/8/1

Y1 - 2019/8/1

N2 - 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 MetaAnalysis 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.

AB - 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 MetaAnalysis 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.

KW - Bevacizumab

KW - Epistaxis

KW - GI-bleeding

KW - HHT

KW - Hereditary haemorrhagic telangiectasia

U2 - 10.4193/Rhin18.289

DO - 10.4193/Rhin18.289

M3 - Review

VL - 57

SP - 242

EP - 251

JO - Rhinology

JF - Rhinology

SN - 0300-0729

IS - 4

ER -