Emerging role of thalidomide in the treatment of gastrointestinal bleeding

McFarlane, Michael; O’Flynn, Lauren; Ventre, Rachel; Disney, Benjamin

doi:10.1136/flgastro-2017-100870

Cited by 11 publications

(9 citation statements)

References 58 publications

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“…Medical therapies, including corticosteroids and octreotide, have been trialled and described in short case series or case reports or small clinical trials [11][12][13][14] . However, there is no clear benefit with any of these.…”

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

Magee

Graham

Leonard

et al. 2020

Current Medical Research and Opinion

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Objective: This economic evaluation aims to provide a preliminary assessment of the cost-effectiveness of radiofrequency ablation (RFA) compared with argon plasma coagulation (APC) when used to treat APC-refractory gastric antral vascular ectasia (GAVE) in symptomatic patients. Methods: A Markov model was constructed to undertake a cost-utility analysis for adults with persistent symptoms secondary to GAVE refractory to first line endoscopic therapy. The economic evaluation was conducted from a UK NHS and personal social services (PSS) perspective, with a 20year time horizon, comparing RFA with APC. Patients transfer between health states defined by haemoglobin level. The clinical effectiveness data were sourced from expert opinion, resource use and costs were reflective of the UK NHS and benefits were quantified using Quality Adjusted Life Years (QALYs) with utility weights taken from the literature. The primary output was the Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per QALY gained. Results: Over a lifetime time horizon, the base case ICER was £4840 per QALY gained with an 82.2% chance that RFA was cost-effective at a threshold of £20,000 per QALY gained. The model estimated that implementing RFA would result in reductions in the need for intravenous iron, endoscopic intervention and requirement for blood transfusions by 27.1%, 32.3% and 36.5% respectively. Compared to APC, RFA was associated with an estimated 36.7% fewer procedures. Conclusions: RFA treatment is likely to be cost-effective for patients with ongoing symptoms following failure of first line therapy with APC and could lead to substantive reductions in health care resource.

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Section: Introductionmentioning

confidence: 99%

The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

Magee

Graham

Leonard

et al. 2020

Current Medical Research and Opinion

View full text Add to dashboard Cite

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“…Medical therapies, including corticosteroids, tranexamic acid, thalidomide and octreotide, have been trialled and described in short case series or case reports or small clinical trials. [14][15][16][17] Surgical treatment (antrectomy) can be definitive for GAVE by removing the affected mucosa. 18,19 Particularly in those with diseases such as liver cirrhosis, however, the mortality and morbidity associated with surgery can be high and therefore outweigh any potential benefit.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of the underlying disease is recommended. Medical therapies, including corticosteroids, tranexamic acid, thalidomide and octreotide, have been trialled and described in short case series or case reports or small clinical trials 14–17 …”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia

et al. 2019

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Background: Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding, often causing iron deficiency anaemia. Previous studies have looked at the management of this with argon plasma coagulation, laser therapy and endoscopic band ligation. Methods: This was a single-centre prospective study to evaluate the efficacy and safety of radiofrequency ablation (RFA) in patients with GAVE with persistent anaemia refractory to at least one session of first-line endoscopic therapy. Patients were treated with a through-the-scope (TTS) radiofrequency catheter at two endoscopic sessions six weeks apart. The primary outcome was change in haemoglobin at six months posttreatment. The secondary outcomes were reduction in blood or iron requirements, endoscopic surface area regression and complications. Results: Twenty patients were treated. The mean change in haemoglobin at six months was þ12.6 g/l (95% confidence interval 11.7-24.3 g/l), paired t test p < 0.001. At six months, three of 14 individuals who had required blood transfusions had ongoing blood transfusions and five of 17 who had required iron had ongoing iron needs. Surface area regression was scored as 74% AE 25% but no correlation was seen between this and other outcomes. Three of 20 patients experienced pain which was managed with oral analgesia. Of the 14 patients who had reached 12-month follow-up, three required retreatment (21%). Discussion: This small study suggests that RFA is a safe and effective treatment for GAVE. Our study uses the TTS catheter compared to other studies, and demonstrates prolonged improvement in haemoglobin and reduction in blood and iron requirements with a novel assessment of surface area regression.

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“…9 In view of this potential, under rigid regulation, thalidomide is currently being used for several diseases including erythema nodosum leprosum, Kaposi sarcoma associated with HIV-1, multiple myeloma, and advanced prostate cancer. 10 Within this context, thalidomide acts in the endometrioses pathophysiological pathways. Thalidomide, although little explored, is a drug with great potential for the treatment of this disease, as it is able to act both in the control of progression and in the recurrence of the disease after the surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Thalidomide Reduces Cell Proliferation in Endometriosis Experimentally Induced in Rats

Antônio

Silva

Machado

et al. 2019

Rev Bras Ginecol Obstet

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Objective To analyze the effect of thalidomide on the progression of endometriotic lesions experimentally induced in rats and to characterize the pattern of cell proliferation by immunohistochemical Proliferating Cell Nuclear Antigen (PCNA) labeling of eutopic and ectopic endometrium. Methods Fifteen female Wistar rats underwent laparotomy for endometriosis induction by resection of one uterine horn, isolation of the endometrium and fixation of a tissue segment to the pelvic peritoneum. Four weeks after, the animals were divided into 3 groups: control (I), 10mg/kg/day (II) and 1mg/kg/day (III) intraperitoneal thalidomide for 10 days. The lesion was excised together with the opposite uterine horn for endometrial gland and stroma analysis. Eutopic and ectopic endometrial tissue was submitted to immunohistochemistry for analysis of cell proliferation by PCNA labeling and the cell proliferation index (CPI) was calculated as the number of labeled cells per 1,000 cells. Results Group I showed a mean CPI of 0.248 ± 0.0513 in the gland and of 0.178 ± 0.046 in the stroma. In contrast, Groups II and III showed a significantly lower CPI, that is, 0.088 ± 0.009 and 0.080 ± 0.021 for the gland (p < 0.001) and 0.0945 ± 0.0066 and 0.075 ± 0.018 for the stroma (p < 0.001), respectively. Also, the mean lesion area of Group I was 69.2 mm2, a significantly higher value compared with Group II (49.4 mm2, p = 0.023) and Group III (48.6 mm2, p = 0.006). No significant difference was observed between Groups II and III. Conclusion Thalidomide proved to be effective in reducing the lesion area and CPI of the experimental endometriosis implants both at the dose of 1 mg/kg/day and at the dose of 10 mg/kg/day.

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Emerging role of thalidomide in the treatment of gastrointestinal bleeding

Cited by 11 publications

References 58 publications

The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

The cost-effectiveness of radiofrequency ablation for treating patients with gastric antral vascular ectasia refractory to first line endoscopic therapy

Radiofrequency ablation for patients with refractory symptomatic anaemia secondary to gastric antral vascular ectasia

Thalidomide Reduces Cell Proliferation in Endometriosis Experimentally Induced in Rats

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