Treatments of Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Network Meta-Analysis.

IF 5.4 2区医学 Q1 ALLERGY Current Allergy and Asthma Reports Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI:10.1007/s11882-023-01116-8

Wirach Chitsuthipakorn, Minh P Hoang, Dichapong Kanjanawasee, Kachorn Seresirikachorn, Kornkiat Snidvongs

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Abstract

Purpose of review: To analyze and compare the effects of epistaxis treatments for Hereditary Hemorrhagic Telangiectasia (HHT) patients.

Recent findings: Of total of 21 randomized controlled trials (RCT), the data from 15 RCTs (697 patients, 7 treatments: timolol, propranolol, bevacizumab, doxycycline, tacrolimus, estriol/estradiol, and tranexamic acid) were pooled for the meta-analyses while the other 6 studies (treatments: electrosurgical plasma coagulation, KTP laser, postoperative packing, tamoxifen, sclerosing agent, and estriol) were reviewed qualitatively. When compared to placebo, propranolol offered the most improved epistaxis severity score, mean difference (MD), -1.68, 95% confidence interval (95%CI) [-2.80, -0.56] followed by timolol, MD -0.40, 95%CI [-0.79, -0.02]. Tranexamic acid significantly reduced the epistaxis frequency, MD -1.93, 95%CI [-3.58, -0.28]. Other treatments had indifferent effects to placebo. Qualitative analysis highlighted the benefits of tamoxifen and estriol. The adverse events of tranexamic acid, tacrolimus, propranolol, and estradiol were significantly reported. Propranolol, timolol, tranexamic acid, tamoxifen, and estriol were effective treatments which offered benefits to HHT patients in epistaxis management. Adverse events of tranexamic acid, tacrolimus, propranolol, and estradiol should be concerned.

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遗传性出血性毛细血管扩张患者鼻出血的治疗:系统评价和网络荟萃分析。

目的:分析和比较鼻出血治疗遗传性出血性毛细血管扩张症(HHT)的效果。近期发现:在21项随机对照试验(RCT)中，15项随机对照试验(697例患者，7种治疗方法:替马洛尔、心得洛尔、贝伐单抗、强力霉素、他克莫司、雌三醇/雌二醇和氨甲环酸)的数据被纳入meta分析，而另外6项研究(治疗方法:电刀血浆凝固、KTP激光、术后填充、他莫昔芬、硬化剂和雌三醇)的数据被定性回顾。与安慰剂相比，心得安改善鼻出血严重程度评分最高，平均差值(MD)为-1.68,95%可信区间(95% ci)[-2.80， -0.56]，其次是替莫洛尔，MD为-0.40,95% ci[-0.79， -0.02]。氨甲环酸显著降低鼻出血频率，MD -1.93, 95%CI[-3.58， -0.28]。其他治疗方法与安慰剂效果无关。定性分析强调了他莫昔芬和雌三醇的益处。氨甲环酸、他克莫司、心得安和雌二醇的不良事件有显著的报道。心得安、替洛尔、氨甲环酸、他莫昔芬和雌三醇是治疗HHT患者鼻出血的有效药物。应注意氨甲环酸、他克莫司、心得安和雌二醇的不良反应。

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来源期刊

Current Allergy and Asthma Reports 医学-过敏

CiteScore

11.20

自引率

1.80%

发文量

审稿时长

6-12 weeks

期刊介绍： The aim of Current Allergy and Asthma Reports is to systematically provide the views of highly selected experts on current advances in the fields of allergy and asthma and highlight the most important papers recently published. All reviews are intended to facilitate the understanding of new advances in science for better diagnosis, treatment, and prevention of allergy and asthma. We accomplish this aim by appointing international experts in major subject areas across the discipline to review select topics emphasizing recent developments and highlighting important new papers and emerging concepts. We also provide commentaries from well-known figures in the field, and an Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. Over a one- to two-year period, readers are updated on all the major advances in allergy and asthma.

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