Thalidomide for improving cutaneous and pulmonary sarcoidosis in patients resistant or with contraindications to corticosteroids.

Abstract

BACKGROUND:

Limited data report thalidomide improves cutaneous sarcoidosis; no benefit has been reported for pulmonary localization.

OBJECTIVES:

To evaluate feasibility and efficacy of prolonged treatment with thalidomide for cutaneous sarcoidosis associated to pulmonary involvement in patients with resistance or contraindications to steroids.

METHODS:

Nineteen patients were treated with thalidomide for 24 months starting with 200 mg/d for first 2 weeks, followed by 100 mg/d for 11 weeks and a maintenance dose of 100mg on alternate days for 35 weeks, and a gradual scaling down until therapy interruption. Criteria of efficacy were: skin score, serum ACE levels (s-ACE), chest X-ray (CXR), lung function tests (LFTs), and diffusing lung capacity for CO (DLCO). The skin score was computed as arithmetic sum of seven score parameters (min: 0, max: 28).

RESULTS:

Skin score significantly decreased (P<0.001). Lower skin scores occurred after 3 and 6 months (P<0.05). s-ACE levels decreased over time at the third month (P<0.001). CXR assessed by radiological stage significantly improved during the first 6 months (P<0.001). DLCO showed a continuous trend of improvement. Minor side effects that have forced the suspension of the drug were drowsiness/sedation (74%), constipation (68%), and weight gain (53%). Deep vein thrombosis of the lower limbs occurred in one patient (who did not drop out the study). Eight patients (42%) abandoned thalidomide for axonal sensitive peripheral neuropathy (PN) between the ninth and the 24th month of treatment.

CONCLUSIONS:

Thalidomide, long-term at mid-low doses, can be considered as an effective therapeutic alternative in chronic sarcoidosis with resistance or contraindications to steroids.

• Authors: P Fazzi, E Manni, R Cristofani, G Cei, S Piazza, R Calabrese, A Antonelli, G Siciliano, P Barachini, A Carpi
• Journal: Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie (Biomed Pharmacother) Vol. 66 Issue 4 Pg. 300-7 (Jun 2012) ISSN: 1950-6007 [Electronic] France
• PMID: 22494798 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Chemical References

• Glucocorticoids
• Immunosuppressive Agents
• Thalidomide

Topics

• Adult
• Aged
• Contraindications
• Dose-Response Relationship, Drug
• Drug Resistance
• Feasibility Studies
• Female
• Follow-Up Studies
• Glucocorticoids
• Humans
• Immunosuppressive Agents (administration & dosage, adverse effects, therapeutic use)
• Male
• Middle Aged
• Sarcoidosis (drug therapy, pathology)
• Sarcoidosis, Pulmonary (drug therapy, pathology)
• Skin Diseases (drug therapy, pathology)
• Thalidomide (administration & dosage, adverse effects, therapeutic use)
• Time Factors
• Treatment Outcome