Intranasal bleomycin versus Avastin® sclerotherapy as an adjunct to laser treatment for epistaxis in hereditary hemorrhagic telangiectasia

Background Hereditary hemorrhagic telangiectasia is a rare disease of vascular development, often accompanied by severe epistaxis. Multimodality treatment may improve epistaxis control, but the optimal combination of modalities has not yet been established. Objective To compare the effects of adding intranasal bleomycin versus Avastin® sclerotherapy to laser treatment for epistaxis in patients with hereditary hemorrhagic telangiectasia. Methods We retrospectively studied the medical records of all hereditary hemorrhagic telangiectasia patients who underwent laser therapy with or without bleomycin or Avastin® sclerotherapy for epistaxis during eight consecutive years. We calculated the mean posttreatment epistaxis severity score changes, proportions of procedures after which a minimal important difference in epistaxis severity score was reached, and intervals between subsequent treatments. Results The mean epistaxis severity score change was significantly higher after laser combined with bleomycin, compared to laser treatment alone. The mean treatment interval after both laser combined with Avastin®, and laser combined with bleomycin, were significantly longer compared to laser treatment alone. Conclusions Adding bleomycin to laser treatment may lead to greater epistaxis severity score improvement compared to laser treatment only or laser combined with Avastin® in patients with hereditary hemorrhagic telangiectasia. Adding bleomycin or Avastin® to laser seems to lengthen treatment intervals compared to laser therapy alone.