Two studies appearing in JAMA examine the effectiveness of nasal sprays to reduce the frequency and duration of nosebleeds caused by hereditary hemorrhagic telangiectasia (HHT), an inherited condition characterized by abnormal blood vessels which are delicate and prone to bleeding.
Epistaxis (nosebleed) are the most frequent and disabling manifestation of HHT. These epistaxis episodes can be severe and life threatening. There is currently no medical or surgical treatment available to cure the nosebleeds definitively. Sophie Dupuis-Girod, M.D., Ph.D., of the Hopital Femme-Mere-Enfants, Bron, France and colleagues evaluated the efficacy of 3 different doses of the drug bevacizumab administered as a nasal spray. Bevacizumab is a monoclonal antibody that slows the growth of new bloods vessels. In this phase 2/3 clinical trial, 80 patients with HHT and a history of nosebleeds were randomly assigned to received placebo or one of three doses of bevacizumab nasal spray (3 doses 14 days apart for a total treatment duration of 4 weeks).
The researchers found that average monthly epistaxis duration measured at 3 months was not significantly different in the patients receiving bevacizumab in comparison with the placebo group or between the bevacizumab groups. Toxicity was low and no severe adverse events were reported. Treatment with bevacizumab had no measurable effect on secondary outcomes including number of epistaxis episodes, quality of life, number of red blood cell transfusions, or hemoglobin and ferritin levels.
The study was terminated prior to phase 3 for treatment futility after interim analysis on the recommendations of an independent data monitoring committee.
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