A Review of the Efficacy of Thalidomide and Lenalidomide in the Treatment of Refractory Prurigo Nodularis

Abstract

Prurigo nodularis (PN) is a chronic dermatoses characterized by intensely pruritic, excoriated, or lichenified nodules. Standard therapy includes corticosteroids, antihistamines, and phototherapy; however, treatment results are often inadequate or transient. Thalidomide and its analogue lenalidomide are immunomodulatory drugs that have successfully been used to treat refractory cases of PN. A systematic review was performed evaluating the use of thalidomide and lenalidomide for PN. Eighteen articles were included in this study in which a total of 106 patients were evaluated, of whom 76 (71.7%) had moderate to significant improvement of PN with the use of thalidomide, lenalidomide, or both. Patients given thalidomide were treated with doses of 50–300 mg daily for 1–142 months, with the majority being treated for less than 1 year. Patients treated with lenalidomide were given a daily dose of 5–10 mg from 3 to 24 months. The most common side effects observed were sedation, gastrointestinal symptoms, and transient peripheral neuropathy. While thalidomide and lenalidomide are drugs that have shown promising results in these studies, caution should be taken in prescribing these medications and patients should be informed about the potential side effects. As such, large-scale randomized controlled trials with long-term follow-up are needed to determine appropriate dosing, efficacy, and toxicity profiles.

Prurigo nodularis: a physician survey to evaluate current perceptions of its classification, clinical experience and unmet need

“…Recently, the EADV published an expert consensus document on the definition, classification and terminology of chronic prurigo. In most cases, the therapies used to treat PN are relatively ineffective, 8,24 as evidenced in this study by the far higher rates of therapy prescription compared with the respective rates of effectiveness. 2,15,16 In this survey, the primary complaint among all respondents' patients was pruritus, which was also likely responsible for the second most common complaint, sleep disturbance.…”

“…Most of the respondents' patients with PN are prescribed systemic treatments and supportive therapy. In most cases, the therapies used to treat PN are relatively ineffective, 8,24 as evidenced in this study by the far higher rates of therapy prescription compared with the respective rates of effectiveness. An exception would be emollients, which are prescribed in the vast majority of cases and were found to be most effective as supportive agents.…”

European S2k Guideline on Chronic Pruritus

“…Several studies have shown a rapid decrease in pruritus on thalidomide (50-300 mg/day) (351,352). In a very recent review the authors refer to how patients were started on higher doses of 200 mg or more daily in earlier studies (353). In the majority of studies since then, however, patients received an initial dose ranging from 50 to 200 mg/day, following which the dosage was tailored according to response or the development of side effects.…”

“…Thalidomide is teratogenic and there is a dose-related risk of neuropathy, especially in high daily doses (> 100 mg/day) (357). In most cases the peripheral neuropathy is reversible (353). Thalidomide could be considered particularly in a palliative setting (358).…”

Prurigo pós radioterapia: estudo clínico, histológico e imunohistoquímico

“…Lenalidomida, é um análogo da talidomida, considerada mais potente e menos neurotóxica. Ambas as medicações já foram utilizadas com sucesso no controle do prurigo (267,268). Há relato isolado que utiliza a imunoglobulina intravenosa no tratamento do PN com sucesso (269).…”