Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China.
Thalidomide is effective for treating severe cutaneous lupus patients. The aim of this study was to observe the optimum effective and maintenance doses of thalidomide to maximize clinical benefit and minimize side effects for patients with cutaneous lupus in China. Sixty-nine patients with lupus rash from eight hospitals in China were enrolled and treated with different doses of thalidomide. We started the dose of thalidomide at 25 mg daily and gradually increased administration dose once a week until erythema was markedly improved. The effective and maintenance doses were documented. The size of skin lesions was noted once a week. Systemic lupus erythematosus disease activity index (SLEDAI) score, levels of erythrocyte sedimentation rate (ESR), and serum TNF-α were measured before and after treatment. The remission rates were evaluated weekly until 8 weeks. Sixty-eight percent of patients showed an effective dose of 50 mg daily; another 13, 10, and 9 % of patients had an effective dose of 100, 75, and 25 mg daily, respectively. The maintenance dose was 50 mg daily for 71 % of the patients, and 100, 75, and 25 mg daily for 9, 14, and 6 % of the patients. SLEDAI score and serum ESR levels significantly decreased 4 weeks after thalidomide treatment. At the end of the fourth week, the rates of complete remission, partial remission, and no response were 56 % (n = 39), 41 % (n = 28), and 3 % (n = 2). At the eighth week, the rate of total remission rose up to 100 %. The most common side effects were drowsiness and constipation. No peripheral neuropathy was observed in these patients. Thalidomide at a dose of 50 mg daily may offer a better benefit to risk ratio in the treatment of Chinese cutaneous lupus patients.
Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
Dandan
D
Wang
Department of Rheumatology, Wuxi People's Hospital, Wuxi, China.
Haifeng
H
Chen
Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
Shiying
S
Wang
Department of Rheumatology, Wuxi People's Hospital, Wuxi, China.
Yaohong
Y
Zou
Department of Rheumatology, Affiliated Hospital of Jiangsu University, Zhenjiang, China.
Jing
J
Li
Department of Rheumatology, Changzhou People's Hospital, Changzhou, China.
Jieping
J
Pan
Department of Rheumatology, Xuzhou No. 4 People's Hospital, Xuzhou, China.
Xiangdang
X
Wang
Department of Rheumatology, Wuxi No. 2 People's Hospital, Wuxi, China.
Tianli
T
Ren
Department of Rheumatology, Subei People's Hospital of Jiangsu Province, Yangzhou, China.
Yu
Y
Zhang
Department of Rheumatology, First Hospital of Suzhou University, Suzhou, China.
Zhiwei
Z
Chen
Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
Xuebing
X
Feng
Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China. lingyunsun@nju.edu.cn.
Lingyun
L
Sun
D000293:Adolescent; D000328:Adult; D001799:Blood Sedimentation; D002681:China; D003248:Constipation / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005076:Exanthema / Q000188:drug therapy*; D005260:Female; D006761:Hospitals; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012894:Sleep Stages / Q000187:drug effects; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D013792:Thalidomide
Cutaneous lupus; Optimum dose; Remission rate; Side effect; Thalidomide