Thalidomide in refractory bleeding due to gastrointestinal angiodysplasias

Abstract

Objectives: to assess the efficacy of thalidomide in the treatment of relapsed or refractory bleeding secondary to gastrointestinal angiodysplasia. Material and methods: we carried out a prospective study of 12 patients with bleeding due to gastrointestinal angiodysplasia refractory to conventional therapy who were treated with thalidomide. For each patient, we considered: age, sex, underlying disease, previous therapies, dose and duration of thalidomide treatment, evolution of haemoglobin levels and adverse effects of treatment. The data obtained were analysed using descriptive statistics with SPSS v. 16. Results: seven men and 5 women with a mean age of 77 years were included in the present study. Five had some underlying pathology and all of them had received prior endoscopic/octreotide treatment. The dose of thalidomide administered was 200 mg/24 h and the duration of the treatment four months, with the exception of two patients in whom treatment was discontinued because of adverse side effects. Mean haemoglobin concentration before onset of treatment was 6.5 g/dL, at two months it was 11.3 g/dL and at the end of treatment 12.1 g/dL. Conclusions: thalidomide is an effective treatment in gastrointestinal bleeding due to angiodysplasia, but it was withdrawn due to side effects in 16% of the patients included in our study.

Medical and Endoscopic Therapies for Angiodysplasia and Gastric Antral Vascular Ectasia: A Systematic Review

“…[26][27][28] A single case series on thalidomide (n ¼ 12) found 17% of patients had side effects, 25% stopped therapy, and no mortality (0%). 29 Endoscopic therapies. These studies are summarized in Table 1.…”

Adjuvant role of anti-angiogenic drugs in the management of head and neck arteriovenous malformations

“…regimen for another 6 month period. Pre-treatment selection of patients must include a careful evaluation of medical history of the patient: the use of this drug is contraindicated in patients with personal history of ADRs with Thalidomide, affected by peripheral neuropathy, in case of pregnancy or planned pregnancies and during acute infections [8,19].…”

“…Severe cases of hepatotoxicity have been reported in the literature, but liver diseases represent a non-absolute criterion of exclusion [8,[19][20][21][22][23].…”

Telangiectasia hemorrágica hereditária: resposta hematológica após terapêutica com talidomida

“…A terapêutica com talidomida pode ter numerosos efeitos adversos 6 , destacando-se, pela elevada frequência, hipocalcémia (72%), edema (57%), neuropatia sensitiva (54%), dispneia (42%), fraqueza muscular (40%), sonolência (36%), neutropenia (31%), confusão (28%) e tromboembolismo venoso (23%), sendo que o uso deste fármaco aumenta o risco de tromboembolismo venoso em 2.6 vezes 7 . Na literatura existem alguns relatos e pequenas séries de pacientes com THH com anemia recorrente tratados com talidomida com sucesso [12][13][14] , embora em alguns pacientes a terapêutica tenha sido abandonada por efeitos colaterais do fármaco 12,13 , e num outro não tenha tido sucesso pleno, com necessidade de intervenção endoscópica para tratamento de angiodisplasia 14 . O nosso paciente destaca-se pela excelente resposta que teve à terapêutica, mesmo com 100mg por dia, sem ocorrência de efeitos colaterais, não necessitando de transfusões de eritrócitos desde há 33 meses.…”

“…Como o nosso paciente se mantém controlado com esta terapêutica, sem ocorrência de efeitos colaterais, não pensamos para já recorrer ao bevacizumab porque, apesar de mais seguro, tem uma toxicidade que não é desprezível, podendo provocar insuficiência cardíaca, hemorragias, tromboembolismo arterial e hipertensão arterial, além de ser mais dispendioso 13. Não existem na literatura recomendações ou consenso quanto à dose e duração do tratamento com talidomida. Com vista à redução da incidência de efeitos colaterais tem-se optado por fazer tratamentos curtos (até 12 meses), repetidos posteriormente se necessário, com doses entre 100mg e 300mg por dia 12,14 . Tem sido essa a estratégia que temos seguido para o nosso paciente.…”