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RecruitingNCT04976036EPISTOPUpdated Mar 11, 2026

Efficacy of Nintedanib for Treatment of Epistaxis in Hereditary Hemorrhagic Telangiectasia (HHT) Patients

A Phase 2 interventional study of Nintedanib and Placebo in Telangiectasia, Hereditary Hemorrhagic, sponsored by Dr. Romain Lazor. Recruiting at 3 sites in 2 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-03-11.

Sponsored by Dr. Romain Lazor · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started May 2022; still recruiting 4 years 6 months later.
Phase
Phase 2
Study type
Interventional
Enrollment
48
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Patients affected by hereditary hemorrhagic telangiectasia (HHT) very often suffer from recurrent nosebleeds called epistaxis. There is no treatment currently available to reduce the frequency or severity of epistaxis.

This research project will examine the effect of nintedanib, a capsule to be taken twice a day, on the frequency and severity of epistaxis in HHT.

The study will take place at the Respiratory medicine department of the Lausanne University Hospital (Centre hospitalier universitaire vaudois, CHUV). The investigators will recruit about 48 participants with HHT, who will be divided in 2 groups. Each group will perform the same examinations and follow-up visits. The study will begin with 2 months of observation during which subjects will be asked to fill a diary to record the number and duration of epistaxis episodes. The diary will be filled daily for the entire duration of the study, i.e. 8 months. After 2 months of observation, the treatment phase will begin. Participants will take a capsule (nintedanib 150 mg or placebo) once a day for 2 weeks, then twice a day for 14 weeks. In case of intolerance at the dose of 2 capsules per day, the treatment may be reduced to 1 capsule per day. Subjects will also have to mention on the diary any blood transfusion, iron perfusion, and any symptoms they may be experiencing. Following the 16 weeks of treatment, an 8-week follow-up period will allow to observe the effects of nintedanib after the end of the treatment period, and to monitor any unexpected adverse events.

Read the detailed description

Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber disease, is a rare genetic disease with autosomal dominant transmission and a prevalence in the general population of 1/5'000 to 1/10'000. Genetic mutations in HHT affect the intracellular angiogenic signalling pathways (for example through the Vascular Endothelial Grow Factor [VEGF]) in endothelial cells. Clinically, HHT leads to arteriovenous malformations in various organs including the lung, brain, liver, digestive tract, skin, and nasal mucosa. More than 90% of HHT patients suffer from chronic nosebleeds called epistaxis, which may lead to severe iron deficiency, anemia requiring recurrent blood transfusions in 10-30%, emergency hospital admissions for acute and sometimes life-threatening bleeding, and moderate to severe reduction in quality of life in about 70%. Nintedanib, an antifibrotic drug approved for the treatment of idiopathic pulmonary fibrosis (IPF), also targets the VEGF receptor. The investigators hypothesize that nintedanib, acting by inhibition of the VEGF receptor, may reduce the duration and frequency of epistaxis in HHT patients.

This hypothesis will be studies in a phase II randomized controlled trial. The study design will be the following:

Pre-therapeutic observation period of 8 weeks followed by a 16-week interventional phase (nintedanib 150 mg once a day for 2 weeks, then twice a day for 14 weeks compared to a placebo at same regimen), and by an 8-week follow-up period to assess post-treatment effects and possible adverse events.

Number of randomized patients: up to 24 in each arm, to achieve at least 16 patients completing the entire study in each arm, with up to 8 drop-out in each arm allowed.

Patients will complete an epistaxis self-administered assessment grid daily since the screening visit, and an epistaxis severity score and a quality of life assessment at the end of weeks 8, 16, 20, 24 and 32.

Blood will be sampled at screening (= week 1), and at weeks 8, 12, 16, 20, 24 and 32 to assess hemoglobin and ferritin levels, and to monitor hepatic or renal functions for safety reasons.

Microphotography (dermoscopy) of selected cutaneous telangiectasia will be performed at visits 1, 6 and 7.

Prior to study initiation, the study protocol, the patient information form and consent form, as well as other study-specific documents will be submitted to the local ethics committee (CER-VD) and the Swiss national drug regulatory authority (Swissmedic) for approval. Any amendment to the protocol must be approved (if legally required) by these institutions.

Participants will be closely monitored for adverse events at each visit. Each participant will hold of an emergency card indicating his/her randomization number, the name and number of the study, the name of the PI, the possible Investigated Medical Product (IMP) i.e. nintedanib or placebo, and the emergency phone number. In case of serious adverse event (SAE), participants may call the emergency number. The call will be answered directly by the PI or a co-investigator.

Individual medical information obtained during the course of this study will be confidential and disclosure to third parties will be prohibited. Confidentiality will also be warranted by using coded subject identification in the computer files.

Only authorized staff of the research team, i.e. the sponsor-PI, investigators, and study nurse will be authorized to access participants data in a password-protected database. After database lock, the Sponsor-PI, investigators and statistician will be able to access the database for analysis. The database will be archived for ten years after study completion.

02

Conditions studied

  • Telangiectasia, Hereditary Hemorrhagic

Keywords

  • nintedanib
  • epistaxis
  • treatment
03

In context

Telangiectasia, Hereditary Hemorrhagic

106 studies on the registry are indexed under Telangiectasia, Hereditary Hemorrhagic; 24 are open to participants now.

This study's planned enrollment of 48 is above the median of 33 across 61 interventional studies indexed under Telangiectasia, Hereditary Hemorrhagic.

Browse Telangiectasia, Hereditary Hemorrhagic studies →

Lead sponsor

This is the only study on the registry with Dr. Romain Lazor as lead sponsor.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. signed
  2. definite HHT disease (defined as the presence of a pathogenic mutation in one of the HHT genes, or the presence of 3 out of 4 Curaçao clinical criteria)
  3. age ≥18 years at the time of informed consent
  4. moderate to serious epistaxis defined as Epistaxis Severity Score (ESS) ≥2.5
  5. absence of cerebral arteriovenous malformation demonstrated by brain imaging

Exclusion criteria

Exclusion criteria:

  1. Women who are pregnant or breastfeeding
  2. For women of (WOCBP, see Annex VII for definition), non-agreement to follow instructions for method(s) of for the heterosexual couple (see Annex VII for instructions) during the treatment period and follow-up, or at least 3 months after the last dose of IMP, or if there are concerns that they will not reliably comply with the contraception requirements.
  3. Acute infection
  4. (AST), or alanine aminotransferase (ALT), or total >1.5x (or >2.5x in patients known for Gilbert's syndrome) the
  5. Renal clearance by formula \<30 ml/min
  6. Untreated pulmonary arteriovenous malformation (if vaso-occlusion is technically feasible)
  7. Hemoptysis or hematuria within the last 12 months
  8. Ulcus or active gastric bleeding within the last 12 months
  9. Anticoagulant or antiplatelets treatment
  10. Coronary heart disease
  11. Thrombotic event within the last 12 months
  12. Long syndrome (on performed at screening)
  13. Known allergy to nintedanib, soya, peanuts
  14. Bevacizumab, pazopanib or other anti-angiogenic treatments within the last 12 months
  15. Concomitant treatment with ketoconazole, erythromycin, rifampicin, carbamazepine, phenytoin, St John's Wort
  16. Surgery within the last 3 months or planned within the next 9 months
  17. Recent unhealed wound
  18. Any other serious underlying medical condition that could interfere with the study treatment and potential adverse events
  19. Any mental or other impairment that may compromise compliance with the study requirements.
Terms in these criteria, in plain language(9)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

ECG (electrocardiogram)

A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
48 participants (estimated)

Study arms

  • Experimental
    Nintedanib

    nintedanib 150 mg once a day for 2 weeks, then twice a day for 14 weeks

    Drug: Nintedanib

  • Placebo comparator
    Placebo

    placebo 150 mg once a day for 2 weeks, then twice a day for 14 weeks

    Drug: Placebo

Interventions

  • 150 mg oral nintedanib soft caps, once a day for 2 weeks and twice a day for 10 weeks (12 hours interval)

  • DrugPlacebo

    150 mg oral placebo soft caps, once a day for 2 weeks and twice a day for 10 weeks (12 hours interval)

06

What researchers measure

Primary outcomes

  1. Change of epistaxis duration in minutes under nintedanib treatment as compared to placebo in HHT patients.

    The primary outcome will be the proportion of patients with at least 30% change of monthly epistaxis duration in minutes after 16 weeks of study treatment (at V6, week 24) compared to baseline (V1, week 8) assessed in nintedanib arm and in placebo arm. * The monthly epistaxis duration after 16 weeks of study treatment is defined as the average of epistaxis duration during the last 12 weeks of study treatment (minutes/4-weeks period averaged for weeks 12 to 24, i.e. V3 to V6) * The monthly epistaxis duration at baseline is defined as the average of epistaxis duration during the observation period (minutes/4-weeks period averaged for weeks 1 to 8, i.e. V0 to V1).

    Time frame: Week 0 to week 7

Secondary outcomes

  1. Change in number of epistaxis episodes per 4 weeks

    Number of epistaxis will be recorded daily by participants on the daily grid and the number of episodes per 4 weeks will be compared between baseline and treatment period at V3-V6

    Time frame: Secondary endpoints will be evaluated at week 8, 16, 20, 24 and 32

  2. Change in the Nasal Outcome for Epistaxis in Hereditary Hemorrhagic Telangiectasia score

    The Nasal Outcome for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT questionnaire) wil be used to measure physical, social and emotional impacts of epistaxis. It is a 29-items questionnaire using a Likert scale. A higher score indicates a worse outcome. Comparison will be made between the observation period and the treatment period and follow-up.

    Time frame: Secondary endpoints will be evaluated at week 8, 16, 20, 24 and 32

  3. Change in number of blood transfusions per 4 weeks

    Participants will record number of blood transfusions on the daily grid. Comparison will be made between the observation period and the treatment period and follow-up.

    Time frame: Secondary endpoints will be evaluated at week 8, 12, 16, 20, 24 and 32

  4. Change in epistaxis severity score (ESS)

    Epistaxis Severity Score (ESS) is a 6-item score. Each answer gives a number of points which is multiplied by a coefficient. The sum of the 6 answers provides the score. A higher score indicates a worse outcome. The score during the observation period will be compared to the score during the treatment period and follow-up.

    Time frame: Secondary endpoints will be evaluated at week 8, 16, 24 and 32

  5. Change in number of iron infusions per 4 weeks

    Participants will record the number of iron perfusions on the daily grid. Comparison will be made between the observation period and the treatment period and follow-up.

    Time frame: Secondary endpoints will be evaluated at week 8, 12, 16, 20, 24 and 32

  6. Change in hemoglobin level in g/l

    Comparison will be made between the observation period and the treatment period and follow-up.

    Time frame: Secondary endpoints will be evaluated at week 8, 12, 16, 20, 24 and 32

  7. Change in ferritin level in ng/ml

    Comparison will be made between the observation period and the treatment period and follow-up.

    Time frame: Secondary endpoints will be evaluated at week 8, 12, 16, 20, 24 and 32

07

Study locations

2 of 3 sites recruiting
  • Lyon University Hospital, Dpt of genetics
    Bron, 69677, France
    Recruiting
  • Clermont-Ferrand university hospital
    Clermont-Ferrand, 63000, France
    Recruiting
  • Angiology Department, Lausanne University Hospital
    Lausanne, Canton of Vaud 1011, Switzerland
    Completed

    Not enrolling at this site.

08

References and documents

Publications

  • Robert F, Desroches-Castan A, Bailly S, Dupuis-Girod S, Feige JJ. Future treatments for hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis. 2020 Jan 7;15(1):4. doi: 10.1186/s13023-019-1281-4. PubMed 31910860 ↗
  • Kovacs-Sipos E, Holzmann D, Scherer T, Soyka MB. Nintedanib as a novel treatment option in hereditary haemorrhagic telangiectasia. BMJ Case Rep. 2017 Jun 26;2017:bcr2017219393. doi: 10.1136/bcr-2017-219393. PubMed 28652319 ↗

Individual participant data

Plan to share: Yes — Data are available on request.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Mar 11, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04976036
Lead sponsor
Dr. Romain Lazor
Responsible party
Dr. Romain Lazor (Principal investigator, Centre Hospitalier Universitaire Vaudois) — Sponsor-investigator
First posted
Jul 26, 2021
Start date
May 5, 2022
Primary completion
Dec 2026 (estimated)
Completion
Dec 2026 (estimated)
Last update
Mar 11, 2026

Study contacts

Romain Lazor, MD
Contact
romain.lazor@chuv.ch
+41 79 556 21 69

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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