Difference between revisions of "Hereditary hemorrhagic telangiectasia"
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| style="background-color:#1a9851" |Phase III (C) | | style="background-color:#1a9851" |Phase III (C) | ||
|[[#Tranexamic_acid_monotherapy|Tranexamic acid]] | |[[#Tranexamic_acid_monotherapy|Tranexamic acid]] | ||
| − | | style="background-color:#ffffbf" |Seems not superior | + | | style="background-color:#ffffbf" |Seems not superior<sup>1</sup> |
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|[https://onlinelibrary.wiley.com/doi/full/10.1111/jth.12654 Gaillard et al. 2014 (ATERO)] | |[https://onlinelibrary.wiley.com/doi/full/10.1111/jth.12654 Gaillard et al. 2014 (ATERO)] | ||
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| − | '' | + | ''<sup>1</sup>In TAHHT, the primary outcome of hemoglobin levels was not statistically significantly different, but the secondary outcome of epistaxis was inferior for this arm.''<br> |
| + | ''Note: No active treatment.'' | ||
===References=== | ===References=== | ||
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| style="background-color:#1a9851" |Phase III (E-esc) | | style="background-color:#1a9851" |Phase III (E-esc) | ||
|[[#Placebo|Placebo]] | |[[#Placebo|Placebo]] | ||
| − | | style="background-color:#ffffbf" |Seems not superior | + | | style="background-color:#ffffbf" |Seems not superior<sup>1</sup> |
|- | |- | ||
|[https://onlinelibrary.wiley.com/doi/full/10.1111/jth.12654 Gaillard et al. 2014 (ATERO)] | |[https://onlinelibrary.wiley.com/doi/full/10.1111/jth.12654 Gaillard et al. 2014 (ATERO)] | ||
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| − | ' | + | '<sup>1</sup>In TAHHT, the primary outcome of hemoglobin levels was not statistically significantly different, but the secondary outcome of epistaxis was superior for this arm.'' |
====Hemostasis therapy==== | ====Hemostasis therapy==== | ||
*[[Tranexamic acid (Cyklokapron)]] | *[[Tranexamic acid (Cyklokapron)]] | ||
Revision as of 16:12, 10 April 2021
| Section editor | |
|---|---|
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Benjamin Tillman, MD Vanderbilt University Nashville, TN |
2 regimens on this page
2 variants on this page
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Guidelines
International Guidelines
- 2020: Faughnan et al. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia
Older
- 2009: Faughnan et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia
All lines of therapy
Placebo
| back to top |
Regimen
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| Yaniv et al. 2009 | Randomized Phase II (C) | Tamoxifen | Inferior frequency of epistaxis |
| Geisthoff et al. 2014 (TAHHT) | Phase III (C) | Tranexamic acid | Seems not superior1 |
| Gaillard et al. 2014 (ATERO) | Phase III (C) | Tranexamic acid | Longer mean duration of epistaxis |
| Dupuis-Girod et al. 2016 (ALEGORI) | Randomized Phase II (C) | Bevacizumab nasal spray | Seems not superior |
| Whitehead et al. 2016 (NOSE) | Randomized Phase II (C) | 1. Bevacizumab nasal spray 2. Estriol nasal spray 3. Tranexamic acid |
Seems not superior |
1In TAHHT, the primary outcome of hemoglobin levels was not statistically significantly different, but the secondary outcome of epistaxis was inferior for this arm.
Note: No active treatment.
References
- Yaniv E, Preis M, Hadar T, Shvero J, Haddad M. Antiestrogen therapy for hereditary hemorrhagic telangiectasia: a double-blind placebo-controlled clinical trial. Laryngoscope. 2009 Feb;119(2):284-8. link to original article PubMed
- TAHHT: Geisthoff UW, Seyfert UT, Kübler M, Bieg B, Plinkert PK, König J. Treatment of epistaxis in hereditary hemorrhagic telangiectasia with tranexamic acid - a double-blind placebo-controlled cross-over phase IIIB study. Thromb Res. 2014 Sep;134(3):565-71. Epub 2014 Jun 16. link to original article PubMed
- ATERO: Gaillard S, Dupuis-Girod S, Boutitie F, Rivière S, Morinière S, Hatron PY, Manfredi G, Kaminsky P, Capitaine AL, Roy P, Gueyffier F, Plauchu H; ATERO Study Group. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease. J Thromb Haemost. 2014 Sep;12(9):1494-502. Epub 2014 Jul 29. link to original article PubMed
- ALEGORI: Dupuis-Girod S, Ambrun A, Decullier E, Fargeton AE, Roux A, Bréant V, Colombet B, Rivière S, Cartier C, Lacombe P, Chinet T, Blivet S, Blondel JH, Gilbert-Dussardier B, Dufour X, Michel J, Harle JR, Dessi P, Faure F. Effect of Bevacizumab Nasal Spray on Epistaxis Duration in Hereditary Hemorrhagic Telangectasia: A Randomized Clinical Trial. JAMA. 2016 Sep 6;316(9):934-42. link to original article PubMed
- NOSE: Whitehead KJ, Sautter NB, McWilliams JP, Chakinala MM, Merlo CA, Johnson MH, James M, Everett EM, Clancy MS, Faughnan ME, Oh SP, Olitsky SE, Pyeritz RE, Gossage JR. Effect of Topical Intranasal Therapy on Epistaxis Frequency in Patients With Hereditary Hemorrhagic Telangiectasia: A Randomized Clinical Trial. JAMA. 2016 Sep 6;316(9):943-51. link to original article PubMed
Tamoxifen monotherapy
| back to top |
Regimen
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| Yaniv et al. 2009 | Randomized Phase II (E-esc) | Placebo | Superior frequency of epistaxis |
Hormonotherapy
References
- Yaniv E, Preis M, Hadar T, Shvero J, Haddad M. Antiestrogen therapy for hereditary hemorrhagic telangiectasia: a double-blind placebo-controlled clinical trial. Laryngoscope. 2009 Feb;119(2):284-8. link to original article PubMed
Tranexamic acid monotherapy
| back to top |
Regimen
| Study | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|
| Geisthoff et al. 2014 (TAHHT) | Phase III (E-esc) | Placebo | Seems not superior1 |
| Gaillard et al. 2014 (ATERO) | Phase III (E-esc) | Placebo | Shorter mean duration of epistaxis |
'1In TAHHT, the primary outcome of hemoglobin levels was not statistically significantly different, but the secondary outcome of epistaxis was superior for this arm.
Hemostasis therapy
References
- TAHHT: Geisthoff UW, Seyfert UT, Kübler M, Bieg B, Plinkert PK, König J. Treatment of epistaxis in hereditary hemorrhagic telangiectasia with tranexamic acid - a double-blind placebo-controlled cross-over phase IIIB study. Thromb Res. 2014 Sep;134(3):565-71. Epub 2014 Jun 16. link to original article PubMed
- ATERO: Gaillard S, Dupuis-Girod S, Boutitie F, Rivière S, Morinière S, Hatron PY, Manfredi G, Kaminsky P, Capitaine AL, Roy P, Gueyffier F, Plauchu H; ATERO Study Group. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease. J Thromb Haemost. 2014 Sep;12(9):1494-502. Epub 2014 Jul 29. link to original article PubMed
- NOSE: Whitehead KJ, Sautter NB, McWilliams JP, Chakinala MM, Merlo CA, Johnson MH, James M, Everett EM, Clancy MS, Faughnan ME, Oh SP, Olitsky SE, Pyeritz RE, Gossage JR. Effect of Topical Intranasal Therapy on Epistaxis Frequency in Patients With Hereditary Hemorrhagic Telangiectasia: A Randomized Clinical Trial. JAMA. 2016 Sep 6;316(9):943-51. link to original article PubMed