American experience with low-dose thalidomide therapy for severe cutaneouslupus erythematosus

Background: There is a renewed interest in thalidomide therapy after its su rprising effectiveness in treating erythema nodosum leprosum was first publ ished. Thalidomide has subsequently been reported to be effective in treati ng a number of dermatoses, including cutaneous lupus erythematosus. We exam ined the efficacy and adverse effects of low-dose, long-term thalidomide mo notherapy in 7 patients with various forms of cutaneous lupus erythematosus that were unresponsive to traditional systemic treatments. Observations: Six of the 7 patients treated with thalidomide after disconti nuation of other oral agents had complete or marked resolution of their pre viously treatment-resistant cutaneous lesions, with an average response tim e of 2.2 +/- 0.8 months. Our cohort of 7 patients with cutaneous lupus eryt hematosus was treated with thalidomide therapy for an average of 2.4 +/- 3. 1 years (range, 1 month to 9 years). The most common adverse effects were s edation, constipation, and weight gain. Two patients reported experiencing intermittent shaking episodes, an adverse effect not previously reported in the literature. Four patients reported symptoms of paresthesia, but none w as found to be caused by thalidomide-induced peripheral neuropathy. Conclusions: A low starting dose of thalidomide as a monotherapy with conti nued sun avoidance is a safe and effective treatment for the various cutane ous manifestations of lupus erythematosus after traditional therapeutic opt ions have failed to control disease. Our experience with low-dose, long-ter m thalidomide therapy suggests that peripheral neuropathy is not as common as suggested by other studies (up to 50% of patients treated with thalidomi de in some series).