An international, multicenter study of intravenous bevacizumab for bleeding in hereditary hemorrhagic telangiectasia: The InHIBIT-bleed study

Hanny Al-Samkari*, Raj S. Kasthuri, Joseph G. Parambil, Hasan A. Albitar, Yahya A. Almodallal, Carolina Vázquez, Marcelo M. Serra, Sophie Dupuis-Girod, Craig B. Wilsen, Justin P. McWilliams, Evan H. Fountain, James R. Gossage, Clifford R. Weiss, Muhammad A. Latif, Assaf Issachar, Meir Mei-Zahav, Mary E. Meek, Miles Conrad, Josanna Rodriguez-Lopez, David J. KuterVivek N. Iyer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Hereditary hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu disease) is a rare multisystem vascular disorder that causes chronic gastrointestinal bleeding, epistaxis, and severe anemia. Bevacizumab, an anti-vascular endothelial growth factor antibody, may be effective to treat bleeding in HHT. This international, multicenter, retrospective study evaluated the use of systemic bevacizumab to treat HHT-associated bleeding and anemia at 12 HHT treatment centers. Hemoglobin, Epistaxis Severity Score (ESS), red cell units transfused, and intravenous iron infusions before and after treatment were evaluated using paired means testing and mixed-effects linear models. Bevacizumab was given to 238 HHT patients for a median of 12 (range, 1-96) months. Compared with pretreatment, bevacizumab increased mean hemoglobin by 3.2 g/dL (95% confidence interval: 2.9-3.5 g/dL); i.e., from a mean hemoglobin of 8.6 (8.5-8.8) g/dL to 11.8 (11.5-12.1) g/dL; P<0.0001) and decreased the ESS by 3.4 (3.2-3.7) points (mean ESS 6.8 [6.6-7.1] versus 3.4 [3.2-3.7]; P<0.0001) during the first year of treatment. Compared with 6 months before treatment, the number of red blood cell units transfused decreased by 82% (median of 6.0 [interquartile range, 0.0-13.0] units versus 0 [0.0-1.0] units; P<0.0001) and iron infusions decreased by 70% (median of 6.0 [1.0-18.0] infusions versus 1.0 [0.0-4.0] infusions, P<0.0001) during the first 6 months of bevacizumab treatment. Outcomes were similar regardless of the underlying pathogenic mutation. Following initial induction infusions, continuous/scheduled bevacizumab maintenance achieved higher hemoglobin and lower ESS than intermittent/as-needed maintenance but with more drug exposure. Bevacizumab was well tolerated: hypertension, fatigue, and proteinuria were the most common adverse events. Venous thromboembolism occurred in 2% of patients. In conclusion, systemic bevacizumab was safe and effective for managing chronic bleeding and anemia in HHT.

Original languageEnglish
Pages (from-to)2161-2169
Number of pages9
Issue number8
StatePublished - Aug 2021


FundersFunder number
Agios, Dova and Amgen
American Society of Hematology
Bristol-Myers Squibb
Takeda Pharmaceuticals U.S.A.
Kyowa Kirin Pharmaceutical Development


    Dive into the research topics of 'An international, multicenter study of intravenous bevacizumab for bleeding in hereditary hemorrhagic telangiectasia: The InHIBIT-bleed study'. Together they form a unique fingerprint.

    Cite this