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Low-Dose Thalidomide Combats Refractory Lupus

Low-dose thalidomide should be given prime consideration as a treatment for anti-malarial drug-resistant interface lesions of lupus erythematosus.

It has shown promise as a treatment for the cutaneous manifestations of the disease, report dermatology and rheumatology specialists at Wake Forest University School of Medicine, Winston-Salem, North Carolina.

They point out that thalidomide is an anti-inflammatory agent and an immunomodulator which inhibits the production of tumour necrosis factor.

The researchers reviewed medical records of 29 patients with refractory cutaneous lupus who were unresponsive to conventional agents, including anti-malarial agents. This was to assess clinical response per subtype of the disease, the duration of therapy before clinical improvement, and the incidence of adverse effects, including peripheral neuropathy.

Of the 29 patients, 23 who took low-dose thalidomide 100 mg. daily for one month or more were included in the analysis. Clinical responses were assessed by the investigators based on statements of improvement listed in the clinic notes and responses categorised as complete, partial or none.

Seventeen patients (73.9%), achieved complete resolution of the cutaneous manifestations of lupus erythematosus. Three patients (13%) showed partial improvement of 75% and three showed partial improvement of less than 75%.

All but two of the 21 patients showing complete or partial response did so within eight weeks of starting on thalidomide.
Archives of Dermatology 2003;139:1:50-54. "Low-Dose Thalidomide Therapy for Refractory Cutaneous Lesions of Lupus Erythematosus"

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