Update on therapy - thalidomide in the treatment of lupus

Thalidomide has been shown to be an effective treatment for cutaneous forms of lupus erythematous refractory to other therapies. Thalidomide has very serious side effects, including teratogenicity and neuropathy, which limit its clinical use in lupus to such severe refractory cases. Efficacy has bee n confirmed in several studies, although recurrence after discontinuation o f treatment is frequent. More recent experience suggests that lower doses t han originally used may be effective, which may result in a reduction in si de effects. Much effort has been expended in studying the mechanisms of act ion of thalidomide, although as yet it is unclear which of the mechanisms i dentified to date contribute to its efficacy in treating cutaneous forms of lupus erythematosus. Identification of patients suitable for thalidomide t herapy requires a rigorous selection process. Potential side effects should be clearly explained, particularly teratogenicity as many patients are you ng women. Written consent and a negative pregnancy test must be obtained pr ior to commencement of therapy. Reliable contraceptive measures should be s trictly observed by patients taking thalidomide. Close clinical and neuroph ysiological supervision using nerve conduction studies should be undertaken .