{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:42:18Z","timestamp":1790649738385,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T00:00:00Z","timestamp":1519257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Long\u2010term follow\u2010up of intranasal bevacizumab therapy in hereditary hemorrhagic telangiectasia (HHT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective, noncomparative study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients treated for HHT\u2010associated epistaxis by intranasal submucosal bevacizumab injections between June 2011 and August 2013 were included and followed prospectively. The effectiveness of the treatment was evaluated by the epistaxis severity score (ESS); the epistaxis intensity, frequency, and the need of blood transfusion (IFT) score; and hemoglobin levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010three patients were included. The total number of treatments with intranasal bevacizumab injection was 210. The mean number of treatments per patient was 6.2\u2009\u00b1\u20094.6 (range, 1\u201316), and the mean treatment and observation period was 38.8\u2009\u00b1\u200921.8 months (range, 2\u201366 months). Four patients showed no improvement after treatment. Eleven patients (33.3%) showed initial improvement in both ESS and IFT, but the treatment was discontinued before the end of the study because the effect became gradually shorter lasting despite repeated injections. Twelve patients (36.3%) continued to have a positive response to the treatment at the end of the study. No local adverse effects were observed, but one patient developed osteonecrosis in both knees during the treatment period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Intranasal bevacizumab injection is an effective treatment for most of the moderate and severe grades of HHT\u2010associated epistaxis. The duration of the effect of the treatment was variable. Primary and late resistance phenomena to the treatment were quite common.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4. <jats:italic>Laryngoscope<\/jats:italic>, 128:2237\u20132244, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27147","type":"journal-article","created":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T20:25:56Z","timestamp":1519331156000},"page":"2237-2244","source":"Crossref","is-referenced-by-count":15,"title":["Long\u2010term experience with intranasal bevacizumab therapy"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-6043","authenticated-orcid":false,"given":"Johan","family":"Steineger","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terje","family":"Osnes","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery"},{"name":"Institute of Clinical Medicine, Medical Faculty University of Oslo Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8911-3508","authenticated-orcid":false,"given":"Ketil","family":"Heimdal","sequence":"additional","affiliation":[{"name":"Division of Head and Neck and Reconstructive Surgery, Department of Medical Genetics"},{"name":"Center for Rare Diagnosis Oslo University Hospital Rikshospitalet Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinan","family":"Dheyauldeen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,22]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"40","article-title":"Natural history and control of epistaxis in a group of German patients with Rendu\u2010Osler\u2010Weber disease","volume":"43","author":"Folz BJ","year":"2005","journal-title":"Rhinology"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2008.22.3145"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-004-7865-y"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-011-1721-9"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065899782102890"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-006-0561-x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2174\/157016110791330771"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2009.35"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.79.927.18"},{"key":"e_1_2_6_11_1","first-page":"575","article-title":"Does the genotype of HHT patients with mutations of the ENG and ACVRL1 gene correlate to different expression levels of the angiogenic factor VEGF?","volume":"22","author":"Sadick H","year":"2008","journal-title":"Int J Mol Med"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2010.07.001"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000072411"},{"key":"e_1_2_6_14_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"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20159"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2009-0155"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICU.0b013e3282f0ca54"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-006-0147-8"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21417"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0901421"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21345"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20757"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21415"},{"key":"e_1_2_6_24_1","unstructured":"MeerF DischF SnijderRJ WestermannCJJ MagerJJ.Bevacizumab nasal spray for frequent epistaxis in HHT. 9th International Hereditary Hemorrhagic Telangiectasia Scientific Conference May 20\u2013242011; 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