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

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 <i>ACVRL1</i> 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.