Document Detail


Thalidomide for the treatment of chronic gastrointestinal bleeding from angiodysplasias: a case series.
MedLine Citation:
PMID:  19730385     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mucosal angiodysplasias, either inherited or acquired, can cause gastrointestinal bleeding, sometimes refractory to treatment. From earlier case reports, thalidomide has been described to possess some benefits in this disease, but its benefits and risks nevertheless remain unclear.
OBJECTIVES: This pilot study assesses the efficacy, safety, and side-effect of thalidomide in the treatment of patients with chronic gastrointestinal bleeding from angiodysplasias.
METHODS: Patients with chronic angiodysplasia bleeding and requiring ongoing transfusion were eligible for this open nonrandomized study. Thalidomide was started with 50 mg/day and then increased incrementally by 50 mg every week up to 200 mg/day, if tolerated, and continued for 6 months. Adverse events, hemoglobin, blood chemistry, and blood transfusion were monitored during the treatment and for 6-months posttreatment.
RESULTS: Seven patients were recruited in this study. Four patients discontinued thalidomide within 3-8 weeks, because of fatigue (two patients), peripheral neuropathy (one patient), and skin rash (one patient). All side-effects resolved when thalidomide was discontinued. These four patients required the same volume of blood transfusions per month as pre-study. In contrast, the three patients who continued 100-200 mg/day of thalidomide for 6 months did not require any transfusions during the 6 months of medication. During 6-months posttreatment of these three patients, one maintained response without any transfusion for 2 months, then required 1 U of blood every 4 weeks, one patient required 2 U of blood every 3-4 weeks, and one patient died from diabetes complications.
CONCLUSION: Thalidomide should be considered as a therapeutic option in patients who are resistant to conventional therapy, but it has a high discontinuation rate because of its side-effects.
Authors:
Patarapong Kamalaporn; Ramasamy Saravanan; Maria Cirocco; Gary May; Paul Kortan; Gabor Kandel; Norman Marcon
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  21     ISSN:  1473-5687     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-12     Completed Date:  2010-12-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1347-50     Citation Subset:  IM    
Affiliation:
Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Patarakamala@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angiodysplasia / complications*
Angiogenesis Inhibitors / administration & dosage,  adverse effects,  therapeutic use*
Blood Transfusion
Chronic Disease
Drug Administration Schedule
Female
Gastrointestinal Hemorrhage / drug therapy*,  etiology,  therapy
Humans
Male
Middle Aged
Pilot Projects
Thalidomide / administration & dosage,  adverse effects,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiogenesis Inhibitors; 50-35-1/Thalidomide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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