Efficacy of thalidomide therapy in pediatric Crohn’s disease with evidence of tuberculosis

Abstract

AIMTo evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn’s disease (CD) with tuberculosis infection.METHODSA retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year, and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.RESULTSTen patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate, C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.CONCLUSIONThalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.

Thalidomide Prevented and Ameliorated Pathogenesis of Crohn’s Disease in Mice via Regulation of Inflammatory Response and Fibrosis

“…Therefore, refractory CD is still important problems facing clinicians. Thalidomide has been proved to be effective for the treatment of refractory CD (Hu et al, 2016;Simon et al, 2016;Wang et al, 2017;He et al, 2017;Zhu et al, 2017;Lazzerini et al, 2017). Lazzerini et al analyzed long term results of children treated with thalidomide (administered at a daily dosage of 50 mg, 100 mg, or 150 mg for patents <30 kg, 30-60 kg, and >60 kg), 54.3% maintained clinical remission, 41.4% achieved mucosal healing, and 28.6% achieved histologic healing (Lazzerini et al, 2017).…”

“…In 1965, Sheskin first published a series of studies on the successful treatment of erythema nodules of leprosy with thalidomide, suggesting that thalidomide has anti-inflammatory activity (De las Aguas, 1971). Thalidomide is emerging as an alternative treatment of selected patients with refractory CD and widely used in clinic (Hu et al, 2016;He et al, 2017;Wang et al, 2017;Zhu et al, 2017). Thalidomide could promote endoscopic and histologic healing in children with inflammatory bowel disease and induce clinical remission and mucosal healing in adults with active refractory CD (Simon et al, 2016;Lazzerini et al, 2017).…”

The Dark Side of the Covid-19 Treatments on Mycobacterium Tuberculosis Infection

“…Thalidomide represents a compound that has been tested against Mtb infection showing a detrimental effect on infection control due to TNF-α inhibition with consequent increase in mycobacterial replication 57 , 58 ( Figure 2 and Table 1 ).…”

Metabolic Programming of Macrophages: Implications in the Pathogenesis of Granulomatous Disease

“…Specifically, HIF-1α links the effector functions of M1 macrophages to their metabolic profile by both activating glycolytic enzymes and directly promoting transcription of the inflammatory mediator IL-1β (36). Moreover, when HIF-1α is overexpressed in macrophages, mitochondrial OXPHOS is suppressed and the cells enter a highly glycolytic and inflammatory state with a clear M1 phenotype (37). It must be noted, however, that the Warburg effect has almost exclusively been observed in vitro and in cancer cells, and it has been proposed that M1 macrophages only exhibit a “Warburg-like” phenotype (38).…”