Skip to main content

Advertisement

SpringerLink
Log in

Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Thalidomide is effective for treating severe cutaneous lupus patients. The aim of this study was to observe the optimum effective and maintenance doses of thalidomide to maximize clinical benefit and minimize side effects for patients with cutaneous lupus in China. Sixty-nine patients with lupus rash from eight hospitals in China were enrolled and treated with different doses of thalidomide. We started the dose of thalidomide at 25 mg daily and gradually increased administration dose once a week until erythema was markedly improved. The effective and maintenance doses were documented. The size of skin lesions was noted once a week. Systemic lupus erythematosus disease activity index (SLEDAI) score, levels of erythrocyte sedimentation rate (ESR), and serum TNF-α were measured before and after treatment. The remission rates were evaluated weekly until 8 weeks. Sixty-eight percent of patients showed an effective dose of 50 mg daily; another 13, 10, and 9 % of patients had an effective dose of 100, 75, and 25 mg daily, respectively. The maintenance dose was 50 mg daily for 71 % of the patients, and 100, 75, and 25 mg daily for 9, 14, and 6 % of the patients. SLEDAI score and serum ESR levels significantly decreased 4 weeks after thalidomide treatment. At the end of the fourth week, the rates of complete remission, partial remission, and no response were 56 % (n = 39), 41 % (n = 28), and 3 % (n = 2). At the eighth week, the rate of total remission rose up to 100 %. The most common side effects were drowsiness and constipation. No peripheral neuropathy was observed in these patients. Thalidomide at a dose of 50 mg daily may offer a better benefit to risk ratio in the treatment of Chinese cutaneous lupus patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sheskin J (1965) Thalidomide in the treatment of lepra reactions. Clin Pharmacol Ther 6:303–306

    Article  CAS  PubMed  Google Scholar 

  2. Doherty SD, Hsu S (2008) A case series of 48 patients treated with thalidomide. J Drugs Dermatol 7(8):769–773

    PubMed  Google Scholar 

  3. Gutiérrez-Rodriguez O, Starusta-Bacal P, Gutiérrez-Montes O (1989) Treatment of rheumatoid arthritis: the thalidomide experience. J Rheumatol 16(2):158–163

    PubMed  Google Scholar 

  4. Hamuryudan V, Mat C, Saip S et al (1998) Thalidomide in the treatment of the mucocutaneous lesions of Behcet’s syndrome: a randomised, double-blind, placebo controlled trial. Ann Intern Med 128(6):443–459

    Article  CAS  PubMed  Google Scholar 

  5. Barlogie B, Desikan R, Eddlemon P et al (2001) Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood 98(2):492–494

    Article  CAS  PubMed  Google Scholar 

  6. Reyes-Teran G, Sierra-Madero JG, Martinez del Cerro V et al (1996) Effects of thalidomide on HIV-associated wasting syndrome: a randomised, double blind, placebo-controlled clinical trial. AIDS 10(13):1501–1507

    Article  CAS  PubMed  Google Scholar 

  7. Vogelsang GB, Farmer ER, Hess AD et al (1992) Thalidomide for the treatment of chronic graft-versus-host disease. N Engl J Med 326(16):1055–1058

    Article  CAS  PubMed  Google Scholar 

  8. McHugh SM, Rowland TL (1997) Thalidomide and derivatives: immunological investigations of tumour necrosis factor-alpha (TNF-α) inhibition suggest drugs capable of selective gene regulation. Clin Exp Immunol 110(2):151–154

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Knop J, Bonsmann G, Happle R et al (1983) Thalidomide in the treatment of sixty cases of chronic discoid lupus erythematosus. Br J Dermatol 108(4):461–466

    Article  CAS  PubMed  Google Scholar 

  10. Karim MY, Ruiz-Irastorza G, Khamashta MA, Hughes GRV (2001) Update on therapy-thalidomide in the treatment of lupus. Lupus 10(3):188–192

    Article  CAS  PubMed  Google Scholar 

  11. Thomson KF, Goodfield MJ (2001) Low-dose thalidomide is an effective second-line treatment in cutaneous lupus erythematosus. J Dermatol Treat 12(3):145–147

    Article  CAS  Google Scholar 

  12. Duong DJ, Spigel GT, Moxley TR III, Gaspari AA (1999) American experience with low-dose thalidomide therapy for severe cutaneous lupus erythematosus. Arch Dermatol 135(9):1079–1087

    Article  CAS  PubMed  Google Scholar 

  13. Housman TS, Jorizzo JL, McCarty MA et al (2003) Low-dose thalidomide therapy for refractory cutaneous lesions of lupus erythematosus. Arch Dermatol 139(1):50–54

    Article  CAS  PubMed  Google Scholar 

  14. Cummins DL, Gaspari AA (2004) Photoprotection by thalidomide in patients with chronic cutaneous and systemic lupus erythematosus: discordant effects on minimal erythema dose and sunburn cell formation. Br J Dermatol 151(2):458–464

    Article  CAS  PubMed  Google Scholar 

  15. Smith EL, Shmerling RH (1999) The American College of Rheumatology criteria for the classification of systemic lupus erythematesus: strengths, weaknesses, and opportunities for improvement. Lupus 8(8):586–595

    Article  CAS  PubMed  Google Scholar 

  16. Kuhn A, Ochsendorf F, Bonsmann G (2010) Treatment of cutaneous lupus erythematosus. Lupus 19(9):1125–1136

    Article  CAS  PubMed  Google Scholar 

  17. Kuhn A, Ruland V, Bonsmann G (2011) Cutaneous lupus erythematosus: update of therapeutic options part II. J Am Acad Dermatol 65(6):e195–e213

    Article  PubMed  Google Scholar 

  18. Kaur I, Dogra S, Narang T, De D (2009) Comparative efficacy of thalidomide and prednisolone in the treatment of moderate to severe erythema nodosum leprosum: a randomized study. Australas J Dermatol 50(3):181–185

    Article  PubMed  Google Scholar 

  19. Sadlier M, Kirby B, Lally A (2012) Mycophenolate mofetil and hydroxychloroquine: an effective treatment for recalcitrant cutaneous lupus erythematosus. J Am Acad Dermatol 66(1):160–161

    Article  PubMed  Google Scholar 

  20. Barba RJ, Franco GF (1977) Fixed lupus erythematosus its treatment with thalidomide. Med Cutan Ibero Lat Am 5(4):279–285

    Google Scholar 

  21. Walchner M, Meurer M, Plewig G, Messer G (2000) Clinical and immunologic parameters during thalidomide treatment of lupus erythematosus. Int J Dermatol 39(5):383–388

    Article  CAS  PubMed  Google Scholar 

  22. Coelho A, Souto MI, Cardoso CR et al (2005) Long-term thalidomide use in refractory cutaneous lesions of lupus erythematosus: a 65 series of Brazilian patients. Lupus 14(6):434–439

    Article  CAS  PubMed  Google Scholar 

  23. Cuadrado MJ, Karim Y, Sanna G, Smith E, Khamashta MA, Hughes GR (2005) Thalidomide for the treatment of resistant cutaneous lupus: efficacy and safety of different therapeutic regimens. Am J Med 118(3):246–250

    Article  CAS  PubMed  Google Scholar 

  24. Cortes-Hernandez J, Torres-Salido M, Castro-Marrero J, Vilardell-Tarres M, Ordi-Ros J (2012) Thalidomide in the treatment of refractory cutaneous lupus erythematosus: prognostic factors of clinical outcome. Br J Dermatol 166(3):616–623

    Article  CAS  PubMed  Google Scholar 

  25. Pagni F, Moltrasio F, Maggioni D et al (2012) (Therapy-related?) large bowel acute ischemia in thalidomide-treated patient. Int J Color Dis 27(2):269–270

    Article  Google Scholar 

  26. Stevens RJ, Andujar C, Edwards CJ et al (1997) Thalidomide in the treatment of the cutaneous manifestations of lupus erythematosus: experience in sixteen consecutive patients. Br J Rheumatol 36(3):353–359

    Article  CAS  PubMed  Google Scholar 

  27. Briani C, Zara G, Rondinone R et al (2005) Positive and negative effects of thalidomide on refractory cutaneous lupus erythematosus. Autoimmunity 38(7):549–555

    Article  CAS  PubMed  Google Scholar 

  28. Sampaio EP, Sarno EN, Galilly R, Cohn ZA, Kaplan G (1991) Thalidomide selectively inhibits tumor necrosis factor alpha production by stimulated human monocytes. J Exp Med 173(3):699–703

    Article  CAS  PubMed  Google Scholar 

  29. Zampieri S, Alaibac M, Iaccarino L et al (2006) Tumour necrosis factor alpha is expressed in refractory skin lesions from patients with subacute cutaneous lupus erythematosus. Ann Rheum Dis 65(4):545–548

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. McHugh SM, Rifkin IR, Deighton J et al (1995) The immunosuppressive drug thalidomide induces T helper cell type 2 (Th2) and concomitantly inhibits Th1 cytokine production in mitogen- and antigen-stimulated human peripheral blood mononuclear cell cultures. Clin Exp Immunol 99(2):160–167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Briani C, Zara G, Rondinone R et al (2004) Thalidomide neurotoxicity: prospective study in patients with lupus erythematosus. Neurology 62(12):2288–2290

    Article  CAS  PubMed  Google Scholar 

  32. Wu JJ, Huang DB, Pang KR, Hsu S, Tyring SK (2005) Thalidomide: dermatological indications, mechanisms of action and side-effects. Br J Dermatol 153(2):254–273

    Article  CAS  PubMed  Google Scholar 

  33. Stephens TD, Bunde CJ, Fillmore BJ (2000) Mechanism of action in thalidomide teratogenesis. Biochem Pharmacol 59(12):1489–1499

    Article  CAS  PubMed  Google Scholar 

  34. El AR, Shamseddeen WA, Taher AT (2007) Thalidomide and thrombosis. A meta-analysis. Thromb Haemost 97(6):1031–1036

    Google Scholar 

  35. Sharma NL, Sharma VC, Mahajan VK et al (2007) Thalidomide: an experience in therapeutic outcome and adverse reactions. J Dermatolog Treat 18(6):335–340

    Article  CAS  PubMed  Google Scholar 

  36. Tektonidou MG, Vlachoyiannopoulos PG (2003) Antiphospholipid syndrome triggered by thalidomide in a patient with discoid lupus erythematosus. Lupus 12(9):723–724

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China

    Dandan Wang, Shiying Wang, Xuebing Feng & Lingyun Sun

  2. Department of Rheumatology, Wuxi People’s Hospital, Wuxi, China

    Haifeng Chen & Yaohong Zou

  3. Department of Rheumatology, Affiliated Hospital of Jiangsu University, Zhenjiang, China

    Jing Li

  4. Department of Rheumatology, Changzhou People’s Hospital, Changzhou, China

    Jieping Pan

  5. Department of Rheumatology, Xuzhou No. 4 People’s Hospital, Xuzhou, China

    Xiangdang Wang

  6. Department of Rheumatology, Wuxi No. 2 People’s Hospital, Wuxi, China

    Tianli Ren

  7. Department of Rheumatology, Subei People’s Hospital of Jiangsu Province, Yangzhou, China

    Yu Zhang

  8. Department of Rheumatology, First Hospital of Suzhou University, Suzhou, China

    Zhiwei Chen

Authors
  1. Dandan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haifeng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yaohong Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jieping Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiangdang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tianli Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zhiwei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Xuebing Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lingyun Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lingyun Sun.

Ethics declarations

Financial and competing interests disclosure

The study was supported by the National Natural Science Foundation of China (NO. 81273304, NO. 81401347), Jiangsu Provincial Natural Science Foundation (BK20140098), Jiangsu Provincial Health Department Foundation (Q201411), and The Scientific Research Project of Nanjing Municipal Health Bureau (YKK14067). The authors have no financial/other relationships such as consultancies, employment, expert testimony, honoraria, speakers bureaus, retainers, stock options, or ownership.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, D., Chen, H., Wang, S. et al. Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China. Clin Rheumatol 35, 1521–1527 (2016). https://doi.org/10.1007/s10067-016-3256-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-016-3256-3

Keywords

Search

Navigation