Safety of intranasal Bevacizumab (avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis§

Authors

  • Sonia Chen IV MS,

    1. University of California , San Diego School of Medicine; San Diego, California, U.S.A.
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  • Tom Karnezis MD,

    1. Division of Otolaryngology—Head and Neck Surgery , University of California, San Diego School of Medicine, San Diego, California, U.S.A.
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  • Terence M. Davidson MD

    Corresponding author
    1. Division of Otolaryngology—Head and Neck Surgery , University of California, San Diego School of Medicine, San Diego, California, U.S.A.
    • Head and Neck Surgery (112C), University of California, San Diego School of Medicine, 3350 La Jolla Village Drive, San Diego, CA 92161
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  • No funding was receied for this work.

  • The authors have no financial disclosures for this article.

  • §

    The authors have no conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Assess for complications of intranasal Bevacizumab application in patients with hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis.

Study Design:

Retrospective chart review.

Methods:

In 58 patients presenting with recurrent HHT epistaxis, Bevacizumab was applied intranasally either as a submucosal injection or as a topical spray between October 2006 and June 2010. In many of the injected patients, the potassium titanyl phosphate (KTP) laser was used adjunctively for vessel photocoagulation. A phone interview was performed in July 2010 to assess for treatment complications.

Results:

Of the 58 treated patients 52 were contacted. Patient surveys were performed 1.5 to 46 months following their initial Bevacizumab treatment. Within the treatment population, five patients had sustained a septal perforation. Notably, these patients were treated early in the study period at which time the cartilaginous septum was often both injected and lasered. Subsequently, the treatment protocol was changed and the cartilaginous septum was neither lasered nor injected. After these changes were made no additional septal perforations were identified. No other adverse events were associated with intranasal Bevacizumab treatment.

Conclusions:

Bevacizumab applied as either a submucosal injection or as a topical nasal spray, with or without application of the KTP laser, is a safe treatment regimen. Still, when Bevacizumab injections are performed, the cartilaginous nasal septum should be avoided as patients may develop septal perforations. Laryngoscope, 2011

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