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Thalidomide in the treatment of refractory cutaneous lupus: prognostic factors of clinical outcome.
MedLine Citation:
PMID:  21999437     Owner:  NLM     Status:  Publisher    
Introduction:  Although, thalidomide has been shown to be effective in patients with refractory cutaneous lupus erythematosus (CLE), its use is still hampered by its potential severe side effects and the current restricted availability. The aim of this observational study is to prospectively evaluate the clinical efficacy and safety of low-dose thalidomide and to establish prognostic factors of clinical outcome. Methods:  Sixty consecutive patients with refractory CLE were treated with thalidomide (100 mg/day). Clinical response was assessed by the CLE disease area and severity index (CLASI). Clinical and immunological parameters were evaluated during treatment. Results:  Patients were followed up to 8 years (2-18). One patient discontinued treatment due to side effects. Of the 59 remaining patients, 58 (98%) achieved clinical response, noticeable already 2 weeks following treatment. Complete response occurred in 50 of them (85%). Clinical relapse was frequent (70%) and usually occurred 5 months after thalidomide's withdrawal or reduction. Subacute cutaneous LE (SCLE) was the predictor factor of long-term remission after therapy discontinuation (odds ratio [OR] 30, 95% confidence interval [95% CI] 5.82-154.63), whereas, discoid LE (DLE) was of relapse (odds ratio [OR] 5.71, 95% confidence interval [95% CI] 1.36-24.06). Eleven patients (18%) reported paresthesia. Nerve conduction studies confirmed a sensory polyneuropathy in 5 of them. Neurological symptoms resolved in 12 months (range 6 to 18) after thalidomide withdrawal. Two patients, heavy smokers and without antiphospholipid antibodies, had a cerebral ischemic event. Conclusions:  Low-dose thalidomide is an effective treatment for refractory CLE, but its benefits need to be balanced with the potential adverse effects. Whereas DLE forms tended to relapse and required a long-term maintenance dose, SCLE forms showed a sustained remission after its withdrawal.
J Cortés-Hernández; M Torres-Salido; J Castro-Marrero; M Vilardell-Tarres; J Ordi-Ros
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-16
Journal Detail:
Title:  The British journal of dermatology     Volume:  -     ISSN:  1365-2133     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 British Association of Dermatologists.
Medicine Department. Systemic Autoimmune Diseases Unit. Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona. Passeig Vall d'Hebron 119-129. 08035 Barcelona, Spain.
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