Nasal RADA16 hydrogel application decreases epistaxis severity scores in adults with hereditary hemorrhagic telangiectasia

Avraham Adelman , Eunice Im , Lindsey Jackson , Anil Patel , Nikita Chapurin , Christina Eagan , Ali Ataya , Marc Zumberg , Jennifer K. Mulligan , Carl Atkinson , Brian C. Lobo , Jeb M. Justice
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Abstract

More than 90% of adults with hereditary hemorrhagic telangiectasia (HHT) experience epistaxis, which can be recurrent and cause significant morbidity. RADA16 is a self-assembling peptide hydrogel approved by the US Food and Drug Administration for hemostasis and wound healing. In this cohort study, we assessed the effectiveness of nasal RADA16 application in controlling HHT-related epistaxis. A retrospective chart review was performed on a cohort of adult patients who received nasal RADA16 without any other changes in treatment. Pre- and post-Epistaxis Severity Scores (ESS), hemoglobin, and hematocrit were collected to assess treatment response. Of the included patients (n = 22), there were 26 applications of RADA16. The cohort was 54.5% male and 86.4% White, had a mean age of 55.5 years, and had a predominantly ACVRL1 genotype (40.9%). Baseline mean ESS was 5.0 and decreased by an average of 2.0 at an average of 46.9 days after treatment, which is 2.8 times more than the minimal clinically important difference for ESS in HHT (0.71). The mean baseline hemoglobin (n = 13) and hematocrit (n = 10), were 11.3 g/dL and 37.5%, respectively, and did not exhibit significant changes after RADA16 application. No bleeding, pain, or allergic reactions occurred due to the application. Several patients reported mild nasal congestion. Our experience demonstrates that RADA16 can be considered as a safe epistaxis treatment modality for HHT that is easy to apply and does not require the operating suite.
鼻腔应用RADA16水凝胶可降低遗传性出血性毛细血管扩张的成人鼻出血严重程度评分
【摘要】成人遗传性出血性毛细血管扩张症(HHT)患者90%以上会发生鼻出血,可反复发作,发病率高。RADA16是一种自组装肽水凝胶,经美国食品和药物管理局批准用于止血和伤口愈合。在这项队列研究中,我们评估了鼻腔RADA16应用在控制hht相关鼻出血中的有效性。对一组接受鼻腔RADA16治疗且未改变其他治疗方法的成年患者进行回顾性图表回顾。收集鼻衄前后严重程度评分(ESS)、血红蛋白和红细胞压积来评估治疗效果。在纳入的患者(n = 22)中,有26例使用了RADA16。该队列中男性占54.5%,白人占86.4%,平均年龄为55.5岁,ACVRL1基因型占40.9%。基线平均ESS为5.0,在治疗后平均46.9天平均下降2.0,这是HHT中ESS最小临床重要差异(0.71)的2.8倍。平均基线血红蛋白(n = 13)和红细胞压积(n = 10)分别为11.3 g/dL和37.5%,应用RADA16后无显著变化。无出血、疼痛或过敏反应发生。几名患者报告轻度鼻塞。我们的经验表明,RADA16可以被认为是HHT的一种安全的鼻出血治疗方式,易于应用,不需要手术套件。
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