
Thalidomide New Uses of an Old Drug . Jeri Benton Johnson, MD Internal Medicine Resident Grand Rounds February 13, 2001. Case presentation.
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Jeri Benton Johnson, MD
Internal Medicine Resident
Grand Rounds
February 13, 2001
Behcet’s syndrome
Crohn’s disease
Lupus Erythematosus
Prurigo nodularis
Multiple myeloma
Wasting syndrome
Aphthous ulcers
Esophageal ulcers
Rheumatoid Arthritis
GVHD
Kaposi’s sarcoma
What is the role of Thalidomide in today’s medicine?Reintroduction of thalidomide for ENL
Mechanisms of action
anti-inflammatory
immunomodulatory
anti-angiogenic
Thalidomide’s effect on HIV
RCT on thalidomide
aphthous ulcers
esophageal ulcers
wasting syndrome
Adverse reactions
Future of thalidomide
S.T.E.P.S.
Conclusion
Overall GoalsHave any of your readers seen similar abnormalities in babies delivered of women who have taken this drug during pregnancy?
W.G.McBride
The Lancet, December 16,1961phocomelia
hypoplasticity of the bones
absence of bones
external ear abnormalities
facial palsy
Eye abnormalities (anophthalmos, microphthalmos)
Congenital heart defects
Alimentary, urinary, and genital malformations
Birth DefectsTreating ENL, Erythema nodosum leprosy
Again used for its sedative properties
ENL
painful vasculitic rash
fever
muscle and joint pain
malaise
weight loss
insomnia
peripheral neuritis
Reintroduction of Thalidomide7/29 had new or worsened peripheral neuropathy
fever
confusion
headaches
nausea
Syncope
lethargy
elevated AST/ALT
Estimated probability of remaining in the study without dose reduction was 52% in the thalidomide group.
Jacobson, et al continuedSide effectsimmunosuppressors
opportunistic infection
Kaposi’s sarcoma
hemoglobin <9.5g/dl
Platlet count<75,000
Creatinine >2mg/dl
AST >3times normal
Total granulocyte <1000 cells/mm3
Gustavo, et al continuedExclusion CriteriaTested initially every wk for the first 4 wks
Tested every 4 wks thereafter if menses are regular
Tested every 2 wks thereafter if menses are irregular
If pregnancy test is positive, FDA is notified; pt is referred to OBGYN for reproductive toxicity
Pregnancy testing in S.T.E.P.S.