title: Bevacizumab: an option for refractory epistaxis in hereditary haemorrhagic telangiectasia.
abstract: BACKGROUND
  Recurrent epistaxis in hereditary haemorrhagic telangiectasia (HHT) patients significantly decreases their quality of life. Treatment in therapy refractory patients is limited although various options have been tested so far.
  
  
  METHODS
  Herein, one patient is described that was treated for HHT for over 20 years with only intermediate benefits. As epistaxis duration and frequency increased continuously, bevacizumab 5 mg/kg was administered every 2 weeks. During the time of treatment (six doses) and up to 3 month afterwards clinical symptoms, blood pressure, cardiac output, pulmonary arterial hypertension (PAH), bleeding duration and frequency were assessed as criteria for treatment benefit.
  
  
  RESULTS
  Duration and frequency of epistaxis decreased immediately after the first application resulting in reduced need of blood transfusions. After completion of six cycles, a further decrease in frequency and duration of bleeding was noted. Cardiac output and PAH decreased or remained stable, respectively, during time and after treatment. No increase in blood pressure could be found but a significant increase in heart rate was experienced after completion of all six applications. Unfortunately, the patient died due to a cerebral abscess.
  
  
  CONCLUSIONS
  Bevacizumab led to an improvement of HHT related epistaxis, refractory to other treatments.
authors.affiliation: Department of Internal Medicine V (Haematology and Oncology), Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria, arno.amann@uki.at.
authors.forename: Arno
authors.initials: A
authors.lastname: Amann
authors.forename: Normann
authors.initials: N
authors.lastname: Steiner
authors.forename: Eberhard
authors.initials: E
authors.lastname: Gunsilius
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D002908:Chronic Disease; D004334:Drug Administration Schedule; D004844:Epistaxis / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control*; D005260:Female; D030342:Genetic Diseases, Inborn / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis* / Q000188:drug therapy* / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab