{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:28:56Z","timestamp":1790702936048,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T00:00:00Z","timestamp":1742169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The evidence\u2010based recommendation for the use of systemic bevacizumab to treat refractory epistaxis in hereditary hemorrhagic telangiectasia (HHT) is based on limited and historical data. An updated synthesis of the available literature is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis were conducted using PRISMA guidelines to evaluate the use of systemic bevacizumab for HHT\u2010related epistaxis. A search was conducted using three databases up to September 2024 for studies assessing the effect of systemic bevacizumab use on epistaxis outcomes in HHT. Outcome measures included epistaxis severity score (ESS), hemoglobin, red blood cell (RBC), and iron transfusion requirements and adverse effects. Random effects meta\u2010analysis was performed for change in ESS (\u0394ESS) and change in hemoglobin (\u0394Hb). Literature quality was assessed using the Joanne Briggs Institute critical appraisal tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 10 studies with 225 total patients were included. Systemic bevacizumab was associated with a significant posttreatment reduction in mean ESS of \u22123.33 (95% CI \u22123.62 to \u22123.03) and a significant increase in mean Hb of 2.38\u00a0g\/dL (95% CI 1.45\u20133.30) compared to pretreatment. All cohort studies found a significant reduction in RBC and iron transfusions following systemic bevacizumab treatment. The most frequently reported adverse effect of systemic bevacizumab was hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Systemic bevacizumab is associated with significant improvements in epistaxis severity, hemoglobin, and transfusion requirements in HHT\u2010related epistaxis. Adequately powered studies are required to strengthen this finding. Patient selection criteria, standardized maintenance dosing, and long\u2010term treatment data require further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alr.23566","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T10:59:31Z","timestamp":1742209171000},"page":"803-817","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Effect of Systemic Bevacizumab on Epistaxis\u2010Related Outcomes in Hereditary Hemorrhagic Telangiectasia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1050-1145","authenticated-orcid":false,"given":"William","family":"Li","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinzi","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Symons","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Banting","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0533-8265","authenticated-orcid":false,"given":"Joanne","family":"Rimmer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health  Melbourne Australia"},{"name":"Department of Otolaryngology Head and Neck Surgery St Vincent's Hospital Melbourne  Fitzroy Australia"},{"name":"Department of Surgery Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2009.35"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2018.193003"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15732-2"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2174\/138161206776361291"},{"key":"e_1_2_7_6_1","volume-title":"Hereditary Hemorrhagic Telangiectasia","author":"McDonald J.","year":"2000"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-017-0586-z"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21374"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1443"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2009.069013"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000072411"},{"issue":"6","key":"e_1_2_7_12_1","first-page":"818","article-title":"Patients With Hereditary Hemorrhagic Telangiectasia Have Increased Plasma Levels of Vascular Endothelial Growth Factor and Transforming Growth Factor\u2010Beta1 as Well as High ALK1 Tissue Expression","volume":"90","author":"Sadick H.","year":"2005","journal-title":"Haematologica"},{"issue":"1","key":"e_1_2_7_13_1","first-page":"15","article-title":"Angiogenesis in Hereditary Hemorrhagic Telangiectasia: VEGF165 Plasma Concentration in Correlation to the VEGF Expression and Microvessel Density","volume":"15","author":"Sadick H.","year":"2005","journal-title":"International Journal of Molecular Medicine"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin17.166"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818797316"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12832"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24367"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2017.11.013"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.250"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20818"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25669"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000450430.97383.64"},{"key":"e_1_2_7_23_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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