Iyer VN, et al. - The researchers performed this study to present a multiyear clinical experience with intravenous bevacizumab for the management of severe gastrointestinal bleeding and/or epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). Findings suggested that for patients with severe anemia related to epistaxis and/or gastrointestinal bleeding, intravenous bevacizumab was an effective treatment option.

Methods

• From June 1, 2013, through January 31, 2017, researchers included all patients treated with intravenous bevacizumab for severe hereditary hemorrhagic telangiectasia–related bleeding in this report.
• Serial collection of data regarding severity of epistaxis (determined using the Epistaxis Severity Score questionnaire); hemoglobin, iron, and ferritin levels; and quality of life in all patients was performed.

Results

• Thirty-four patients received intravenous bevacizumab using a standardized treatment protocol.
• In this study, anemia was observed primarily in association with severe epistaxis (n=15, 44%), severe gastrointestinal bleeding (n=4, 12%), or both (n=15, 44%), with a median baseline hemoglobin level of 9.1 g/dL (range, 8.3-10.5 gm/dL; to convert to mmol/L, multiply by 0.62).
• Twenty-eight patients (82%) recieved red blood cell (RBC) transfusions.
• Sixteen of these patients (47%) were RBC transfusion dependent and received a median of 75 RBC transfusions (range, 4->500 RBC units) before bevacizumab initiation.
• From the beginning of bevacizumab treatment, the median length of follow-up was 17.6 months (range, 3-42.5 months).
• After completion of the initial bevacizumab treatment cycle, researchers noticed a significant reduction in epistaxis severity scores (P < .001) and RBC transfusion requirements (P=.007).
• They noticed new-onset or worsened hypertension in 4 patients, with 1 patient experiencing hypertensive urgency with a temporary decline in renal function.