Efficacy and tolerance profile of thalidomide in cutaneous lupus erythematosus: A systematic review and meta-analysis

Chasset, François; Tounsi, T.; Cesbron, E.; Barbaud, A.; Françès, Camille; Arnaud, Laurent

doi:10.1016/j.jaad.2017.09.059

Cited by 61 publications

(64 citation statements)

References 38 publications

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“…Belimumab and RTX have also shown efficacy in mucocutaneous manifestations of SLE, although these studies have not included a validated activity score for skin lesions; RTX may be less efficacious in chronic forms of skin lupus 62 92–94. Thalidomide is effective in various subtypes of cutaneous disease 95 96. Due to its strict contraindication in pregnancy, the risk for irreversible polyneuropathy, and the frequent relapses on drug discontinuation, it should be considered only as a ‘rescue’ therapy in patients who have failed multiple previous agents.…”

Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Fanouriakis

Kostopoulou

Alunno

et al. 2019

Annals of the Rheumatic Diseases

1,561

1,286

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Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007–12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.

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Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Fanouriakis

Kostopoulou

Alunno

et al. 2019

Annals of the Rheumatic Diseases

1,561

1,286

View full text Add to dashboard Cite

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“…Drowsiness, dizziness, flatulence, constipation, and dry skin are frequent and dose dependent. However, side effects could be more serious, such as an exfoliative dermatitis, toxic epidermolysis, and exacerbation of psoriasis, allergic vasculitis, or hereditary purpura caused by thrombocytopenia [61]. According to several studies, peripheral neuropathy incidence ranges from 20 to 30% for thalidomide-treated CLE patients [23].…”

Section: Limited Clinical Use Of Thalidomide In Dle: Need Of Novel Samentioning

confidence: 99%

Efficacy of Thalidomide in Discoid Lupus Erythematosus: Insights into the Molecular Mechanisms

Domingo¹,

Solé²,

Moliné³

et al. 2020

Dermatology

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Background: Thalidomide has been used successfully in a variety of chronic refractory inflammatory dermatological conditions with underlying autoimmune or infectious pathogenesis. It was first used for refractory discoid lupus erythematosus (DLE) in 1983 and has steadily grown since then. Method: In this review, we describe the therapeutic benefits of thalidomide for DLE treatment and its biological properties. We explain how new discoveries in DLE pathogenesis are relevant to understand thalidomide's mechanism of action and the need to find an alternative safe drug with similar therapeutic effects. Summary: Thalidomide's efficacy in DLE patients is significant, with 80-90% reaching clinical remission according to different studies. However, thalidomide's use is still limited by serious adverse effects such as teratogenicity, neurotoxicity, and thrombosis. In addition, there is a frequent rate of relapse and many patients require a longterm low dose of thalidomide as maintenance. The achievement of clinical response within weeks is key to avoid irreversible DLE fibrotic sequelae, making it critical to introduce thalidomide earlier in the DLE treatment algorithm. Recently, microarray and miRNA screenings demonstrated a significant CD4 + T enrichment and T-helper 1 response predominance with a dysregulation of regulatory T cell (Treg) expression in DLE lesions that induced high levels of proinflammatory, chemotaxis, and apoptotic proteins that induce the chronic inflammation response. Thalidomide's anti-inflammatory, antiangiogenic, and T-cell co-stimulatory effects may be beneficial for DLE since it promotes cytokine inhibition, inhibits macrophage activation, regulates Treg responses, inhibits angiogenesis, modulates T cells, and promotes NK cell-mediated cytotoxicity.

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“…Thalidomide has been shown to be effective in the treatment of DLE. A meta‐analysis found an overall response rate of 90% in 548 patients with chronic lupus erythematosus (CLE) . Although its exact mechanism of action is incompletely understood, thalidomide is hypothesized to exhibit anti‐inflammatory, antiangiogenic, and immunomodulatory effects via inhibition of TNF‐α production.…”

Section: Discussionmentioning

confidence: 99%

Rapid response to treatment with thalidomide in an adolescent with generalized discoid lupus erythematosus

Tran

Abyaneh

2019

Pediatric Dermatology

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Discoid lupus erythematosus (DLE) is the most common variant of cutaneous chronic lupus erythematosus (CLE).Sun protection, topical corticosteroids, and antimalarials constitute the first-line options for treatment. In refractory cases, alternative antimalarials, methotrexate, retinoids, and thalidomide have been utilized. We present a case of an adolescent patient with generalized DLE responding rapidly to thalidomide.

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Efficacy and tolerance profile of thalidomide in cutaneous lupus erythematosus: A systematic review and meta-analysis

Cited by 61 publications

References 38 publications

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Efficacy of Thalidomide in Discoid Lupus Erythematosus: Insights into the Molecular Mechanisms

Rapid response to treatment with thalidomide in an adolescent with generalized discoid lupus erythematosus

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