TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.;
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September 2017Background
Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, often manifests with epistaxis. The disease spectrum is wide; some patients have small, irritating bleeds, whereas other patients require monthly blood transfusions. There are many medical and surgical interventions for epistaxis in HHT, but none have been established as a gold-standard treatment. Bezaciumab (Avastin) is a vascular endothelial growth factor inhibitor. It has been used in various medical conditions, including neurofibromatosis 2 and metastatic colon cancer. Recently, it has been used in HHT as an agent to reduce epistaxis. It can be delivered intranasally (either topically or via submucosal injection) or systemically via intravenous. This review will summarize the most recent and topical evidence for bevacizumab in HHT and aim to answer the question: Is intranasal bevacizumab effective for reducing epistaxis in HHT?
Best Practice
Based on the current evidence, bevacizumab appears to be effective in reducing epistaxis in the HHT patient population. However, it should be noted that the existing literature is limited by small sample sizes and retrospective designs. Due to the rarity of this condition, a multicenter study would be ideal to help confirm these findings and ensure that the study is powered adequately. As well, further research comparing bevacizumab to the other existing therapies are needed to determine superiority (or inferiority) (Laryngoscope. 2017;127:289–290).