Objective: To observe the clinical effects of
bevacizumab in the treatment of familial
epistaxis caused by
hereditary hemorrhagic telangiectasia (HHT). Methods: The data of 27 patients with familial
epistaxis caused by HHT who were treated with
bevacizumab intravenously from Beijing Anzhen Hospital, the First Clinical Center of Chinese People's Liberation Army General Hospital and Binzhou Central Hospital between December 2016 and December 2019 were retrospectively analyzed. There were 14 males and 13 females, aged (55.3±11.2) years. The dose of
bevacizumab was calculated according to the
body weight of 5 mg/kg. The curative effect was observed one month after the first treatment. Visual analogue scale (VAS) was used to compare patients' self-scores of systemic symptoms before and
after treatment.
Epistaxis severity score (ESS) was used to compare and analyze the six problems (including the frequency, duration, intensity, treatment demand,
anemia and
blood transfusion) of the patients before and
after treatment. The changes of
hemoglobin levels before and
after treatment were compared. SPSS 20.0 statistical software was used to process the data. Results: Among the 27 patients at one month after the first
bevacizumab treatment, 22 cases reported that the severity of
epistaxis was improved significantly, and 5 cases reported that the treatment effect was not significant. The effective rate was 81.5% (22/27). The significant effect in 22 patients lasted for 5-24 months, with a median duration of 11.23 months. The VAS score of systemic symptoms decreased significantly compared with that before treatment (2.41±2.55 vs 8.19±1.47, t=9.708, P<0.01). The scores of six aspects and standardized scores of ESS were significantly decreased
after treatment (
epistaxis frequency: 1.78±1.22 vs 3.44±0.80, t=6.814, P<0.01;
epistaxis duration: 0.85±0.91 vs 3.00±0.73, t=8.845, P<0.01;
epistaxis intensity: 0.19±0.40 vs 1.00±0.00, t=10.696, P<0.01; treatment demand: 0.22 ± 0.42 vs 1.00±0.00, t=9.539, P<0.01;
anemia: 0.41±0.50 vs 0.89±0.32, t=4.914, P<0.01;
blood transfusion: 0.11±0.32 vs 0.41±0.50, t=3.309, P<0.01; ESS standardized score: 2.50±2.45 vs 7.60±1.30, t=9.344, P<0.01). The
hemoglobin level
after treatment was significantly higher than that before treatment ((105.48±24.31) g/L vs (73.07±23.71) g/L, t=6.864, P<0.01). Among the 27 patients, there were 8 cases of HHT1 (ENG gene) and 19 cases of HHT2 (ACVRL1 gene). The improvement duration of
epistaxis in group HHT1 and group HHT2 was (4.76±5.12) months and (7.60±10.84) months, respectively, which was in group HHT2 longer than that of group HHT1, but there was no significant difference between the two groups (P>0.05). There was no significant difference in ESS scores between the two groups before and
after treatment (P>0.05). Two female patients had
amenorrhea after the first medication. All patients had no other adverse reactions and complications. Conclusion: Intravenous
bevacizumab is significantly effective and safe in the treatment of familial
epistaxis caused by HHT.