Thalidomide in the treatment of cutaneous lupus refractory to conventional therapy.

Abstract

OBJECTIVE:

We describe a prospective treatment study of thalidomide in a series of 22 patients with cutaneous lupus refractory to other treatments.

METHODS:

From 1992 to 1998, 22 patients with cutaneous lupus (9 with discoid lupus erythematosus, 7 with subacute cutaneous lupus, 4 with profundus lupus, 2 with nonspecific rash) were treated with thalidomide. Initial treatment was started at 100 mg daily. If the cutaneous lesions vanished, the dose was lowered to 50-25 mg daily as a maintenance therapy and it was considered a complete remission. If the lesions improved but remained, this was considered a partial response and treatment was continued until the lesions were not further modified. Periodically, adverse effects were evaluated.

RESULTS:

Three patients discontinued treatment because of side effects such as vertigo, persistent drowsiness, or paresthesia. Rash improved in 16/19 patients (84%). Complete remission occurred in 12/16 (75%). In 9 (65%) the rash resolved, but recurred 4-16 weeks after withdrawal of thalidomide; when it was used again, they improved. Partial response was achieved in 4/16 (25%) patients. No response occurred in 3/19 (16%). Many patients noted improvement within 2 weeks after starting thalidomide and maximum benefit was achieved within 3 months. Five of the 14 women had amenorrhea during the treatment with thalidomide.

CONCLUSION:

Thalidomide is effective in the treatment of cutaneous lupus refractory to other treatments. However, only some patients had a remission; the remainder relapsed when treatment was withdrawn, or required low doses of thalidomide to preserve inactive lesions. Amenorrhea was observed as a new secondary effect of thalidomide.

• Authors: J Ordi-Ros, F Cortés, E Cucurull, M Mauri, S Buján, M Vilardell
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 27 Issue 6 Pg. 1429-33 (Jun 2000) ISSN: 0315-162X [Print] Canada
• PMID: 10852265 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Immunosuppressive Agents
• Thalidomide

Topics

• Adolescent
• Adult
• Amenorrhea (chemically induced)
• Exanthema (drug therapy)
• Female
• Humans
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Lupus Erythematosus, Discoid (drug therapy)
• Male
• Middle Aged
• Prospective Studies
• Remission Induction
• Thalidomide (administration & dosage, adverse effects)
• Treatment Outcome