PMID- 34989143
OWN - NLM
STAT- MEDLINE
DCOM- 20220726
LR  - 20220822
IS  - 2042-6984 (Electronic)
IS  - 2042-6976 (Linking)
VI  - 12
IP  - 8
DP  - 2022 Aug
TI  - Randomized, controlled, double-blinded clinical trial of effect of bevacizumab 
      injection in management of epistaxis in hereditary hemorrhagic telangiectasia 
      patients undergoing surgical cauterization.
PG  - 1034-1042
LID - 10.1002/alr.22961 [doi]
AB  - BACKGROUND: Given its role in the disease pathophysiology, inhibition of vascular 
      endothelial growth factor (VEGF)-mediated angiogenesis has received attention as 
      a potential strategy to reduce epistaxis associated with hereditary hemorrhagic 
      telangiectasia (HHT). In this study we evaluated the efficacy of a submucosal 
      injection of bevacizumab, a VEGF inhibitor, in reducing the severity of epistaxis 
      and improving quality of life when given at the time of operative electrocautery. 
      METHODS: This randomized, double-blinded, placebo-controlled trial was conducted 
      at a single institution from 2014 to 2019. Patients scheduled to undergo 
      operative bipolar electrocautery of nasal telangiectasias were randomized to 
      receive a submucosal injection of saline or bevacizumab at time of surgery. 
      Surveys to assess epistaxis severity and quality of life (QOL), including the 
      Epistaxis Severity Score (ESS) and the 12-item Short Form (SF-12), were 
      administered preoperatively and at 1, 2, 4, and 6 months postoperatively. The 
      minimal clinically important difference (MCID) of the ESS instrument is reported 
      to be 0.71. RESULTS: Of 39 patients enrolled, 37 (94.9%) completed the study. The 
      saline group demonstrated a reduced ESS vs baseline at 1 (-1.2; p = 0.01) and 4 
      (-1.2; p = 0.05) months postprocedure. The bevacizumab group demonstrated a 
      reduced ESS score vs baseline at 1 (-2.3; p < 0.001), 2 (-2.3; p < 0.001), 4 
      (-2.0; p = 0.003), and 6 (-1.3; p = 0.05) months postprocedure. The additive 
      benefit of bevacizumab over saline exceeded the MCID at 1, 2, and 4 months, but 
      the difference was not statistically significant. CONCLUSION: The addition of a 
      single treatment of submucosal bevacizumab may be associated with additional 
      clinically meaningful benefit for up to 4 months when compared with 
      electrocautery alone.
CI  - (c) 2022 ARS-AAOA, LLC.
FAU - Khanwalkar, Ashoke R
AU  - Khanwalkar AR
AUID- ORCID: 0000-0001-9960-7758
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University School of 
      Medicine, Palo Alto, CA.
FAU - Rathor, Aakanksha
AU  - Rathor A
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University School of 
      Medicine, Palo Alto, CA.
FAU - Read, Amelia K
AU  - Read AK
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University School of 
      Medicine, Palo Alto, CA.
FAU - Paknezhad, Hassan
AU  - Paknezhad H
AD  - Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
FAU - Ma, Yifei
AU  - Ma Y
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University School of 
      Medicine, Palo Alto, CA.
FAU - Hwang, Peter H
AU  - Hwang PH
AD  - Department of Otolaryngology-Head and Neck Surgery, Stanford University School of 
      Medicine, Palo Alto, CA.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20220119
PL  - United States
TA  - Int Forum Allergy Rhinol
JT  - International forum of allergy & rhinology
JID - 101550261
RN  - 0 (Vascular Endothelial Growth Factor A)
RN  - 2S9ZZM9Q9V (Bevacizumab)
SB  - IM
MH  - Bevacizumab/therapeutic use
MH  - Cautery
MH  - Epistaxis/drug therapy/etiology/surgery
MH  - Humans
MH  - Quality of Life
MH  - *Telangiectasia, Hereditary Hemorrhagic/complications/drug therapy/surgery
MH  - Vascular Endothelial Growth Factor A/therapeutic use
OTO - NOTNLM
OT  - ESS
OT  - Epistaxis Severity Score
OT  - HHT
OT  - bevacizumab
OT  - bipolar
OT  - electrocautery
OT  - epistaxis
OT  - hereditary hemorrhagic telangiectasis
OT  - quality of life
OT  - therapeutics
EDAT- 2022/01/07 06:00
MHDA- 2022/07/27 06:00
CRDT- 2022/01/06 06:34
PHST- 2021/12/09 00:00 [revised]
PHST- 2021/09/21 00:00 [received]
PHST- 2021/12/27 00:00 [accepted]
PHST- 2022/01/07 06:00 [pubmed]
PHST- 2022/07/27 06:00 [medline]
PHST- 2022/01/06 06:34 [entrez]
AID - 10.1002/alr.22961 [doi]
PST - ppublish
SO  - Int Forum Allergy Rhinol. 2022 Aug;12(8):1034-1042. doi: 10.1002/alr.22961. Epub 
      2022 Jan 19.