Thalidomide and thromboprophylaxis for dermatologic indications: An unmet need for more evidence

Bishnoi, Anuradha; Singh, Vaneet; Handa, Sanjeev; Vinay, Keshavamurthy

doi:10.1016/j.jaad.2018.04.048

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Other side effects that deserve to be mentioned include ovarian toxicity and the risk of thrombotic events [62,63]. Thalidomide could also induce a state of hypercoagulation [64], and this risk can increase significantly in the presence of concomitant oral contraceptive use and antiphospholipid antibodies [65,66]. For this reason, thalidomide treatment is given only for refractory cases.…”

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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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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“…It has been red-flagged and due vigilance is advised, although lack of robust evidence has also been acknowledged. [ 39 40 ] With COVID-19 infection, another pro- coagulatory variable gets added to the mix. It must be noted, that in the absence of routine assessment for ruling out thrombophilia, introducing aspirin (100 mg/day) was part of an existing recommendation for treating ENL.…”

Section: Introductionmentioning

confidence: 99%

Updates on management of leprosy in the context of COVID-19 pandemic: Recommendations by IADVL SIG Leprosy

Bhardwaj

Gupta

Narang

et al. 2021

Indian Dermatol Online J

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The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.

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“…To the Editor: We read with great interest the letter by Bishnoi et al 1 regarding the need for more evidence to support the use of a thromboprophylaxis while prescribing thalidomide in the noncancer setting. Thalidomide is approved by the Food and Drug Administration for the treatment of severe erythema nodosum leprosum, but the drug has been widely used for various inflammatory conditions, including cutaneous lupus erythematosus, mucocutaneous lesions of Behçet disease, oral aphthous, erosive lichen planus, and prurigo nodularis.…”

mentioning

confidence: 99%

Thromboprophylaxis and thalidomide in the noncancer setting: Toward an algorithm that is based on patient risk factors and underlying disease?

Chasset

Arnaud

Françès

2018

Journal of the American Academy of Dermatology

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Thalidomide and thromboprophylaxis for dermatologic indications: An unmet need for more evidence

Cited by 4 publications

References 5 publications

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

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

Updates on management of leprosy in the context of COVID-19 pandemic: Recommendations by IADVL SIG Leprosy

Thromboprophylaxis and thalidomide in the noncancer setting: Toward an algorithm that is based on patient risk factors and underlying disease?

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