Is bevacizumab effective for reducing epistaxis in hereditary hemorrhagic telangiectasia?

BACKGROUND Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, often manifests with epistaxis. The disease spectrum is wide; some patients have small, irritating bleeds, whereas other patients require monthly blood transfusions. There are many medical and surgical interventions for epistaxis in HHT, but none have been established as a gold-standard treatment. Bezaciumab (Avastin) is a vascular endothelial growth factor inhibitor. It has been used in various medical conditions, including neurofibromatosis 2 and metastatic colon cancer. Recently, it has been used in HHT as an agent to reduce epistaxis. It can be delivered intranasally (either topically or via submucosal injection) or systemically via intravenous. This review will summarize the most recent and topical evidence for bevacizumab in HHT and aim to answer the question: Is intranasal bevacizumab effective for reducing epistaxis in HHT?