Thalidomide for chronic sarcoidosis.

Abstract

STUDY OBJECTIVES:

Thalidomide therapy has been shown to modify granulomatous diseases, such as tuberculosis and leprosy. Lupus pernio is a skin manifestation of sarcoidosis that does not remit spontaneously, and was used as a marker of efficacy of thalidomide for sarcoidosis.

DESIGN:

An open-label, dose-escalation trial of thalidomide.

SETTING:

Patients were seen at one of four specialized sarcoidosis clinics in the United States.

PATIENTS:

Fifteen patients with lupus pernio and other manifestations of sarcoidosis unresponsive to prior therapy were enrolled.

INTERVENTIONS:

Skin lesions were assessed with visual examination by the treating physician, and photographic evaluation by a blinded panel of physicians reviewing photographs of the lesions before and after therapy.

MEASUREMENTS AND RESULTS:

Fourteen patients completed 4 months of therapy. All patients experienced some improvement in their skin lesions subjectively, and 10 of 12 evaluable patients showed improvement using photograph scoring. Five patients were better after 1 month (treated with 50 mg/d of thalidomide), seven more patients improved after 2 months (treated with 100 mg/d of thalidomide in the second month), and two patients required an additional month of 200 mg of thalidomide to achieve a response. Patients reported increased somnolence (n = 9), numbness (n = 7), dizziness (n = 2), constipation (n = 6), rash (n = 1), and increasing shortness of breath (n = 1). One patient discontinued therapy because of new-onset dyspnea, due to probably unrelated new-onset congestive heart failure.

CONCLUSION:

Thalidomide was an effective form of treatment for chronic cutaneous sarcoidosis. The drug was well tolerated and may be a useful alternative to systemic corticosteroids.

• Authors: Robert P Baughman, Marc A Judson, Alvin S Teirstein, David R Moller, Elyse E Lower
• Journal: Chest (Chest) Vol. 122 Issue 1 Pg. 227-32 (Jul 2002) ISSN: 0012-3692 [Print] United States
• PMID: 12114363 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunosuppressive Agents
• Thalidomide

Topics

• Adult
• Chronic Disease
• Dose-Response Relationship, Drug
• Female
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Male
• Middle Aged
• Photography
• Sarcoidosis (drug therapy, pathology)
• Skin Diseases (drug therapy, pathology)
• Thalidomide (adverse effects, therapeutic use)
• Treatment Outcome
• United States