title: Safety of intranasal Bevacizumab (Avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis.
abstract: OBJECTIVE
  Assess for complications of intranasal Bevacizumab application in patients with hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis.
  
  
  METHODS
  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.
authors.affiliation: University of California, San Diego School of Medicine, San Diego, California 92161, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Chen
authors.forename: Tom
authors.initials: T
authors.lastname: Karnezis
authors.forename: Terence M
authors.initials: TM
authors.lastname: Davidson
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004844:Epistaxis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D017075:Laser Coagulation; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000187:drug effects; D009300:Nasal Septum / Q000187:drug effects / Q000473:pathology; D059085:Nasal Sprays; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D059085:Nasal Sprays; D000068258:Bevacizumab