One-year prospective nerve conduction study of thalidomide neuropathy in lupus erythematosus: Incidence, coasting effect and drug plasma levels

Autor(es):Mostrar menos -

Yuki, Emily Figueiredo Neves ^[1] ; Soares, Renata ^[2] ; Kupa, Leonard de Vinci Kanda ^[2] ; Heise, Carlos Otto ^[3] ; Aikawa, Nadia Emi ^[1] ; Arnone, Marcelo ^[4] ; Romiti, Ricardo ^[4] ; Pedrosa, Tatiana do Nascimento ^[1] ; Silva, Clovis Artur Almeida da ^[1] ; Bonfa, Eloisa ^[1] ; Pasoto, Sandra Gofinet ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Rheumatol Div, Fac Med, Hosp Clin HCFMUSP, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Div Cent Lab, Fac Med, Hosp Clin HCFMUSP, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Neurol Dept, Fac Med, Hosp Clin HCFMUSP, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Dermatol Dept, Fac Med, Hosp Clin HCFMUSP, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Lupus; v. 30, n. 6 MAR 2021.
• Citações Web of Science: 0

Resumo

Background Few prospective studies in cutaneous and systemic lupus erythematosus (CLE/SLE) assessed thalidomide-induced peripheral neuropathy (TiPN) incidence/reversibility, and most have not excluded confounding causes neither monitored thalidomide plasma levels. Objectives To evaluate TiPN incidence/reversibility, coasting effect and its association with thalidomide plasma levels in CLE/SLE. Methods One-year prospective study of thalidomide in 20 CLE/SLE patients without pregnancy potential, with normal nerve conduction study (NCS), and excluded other PN causes. Thalidomide levels were determined by high-performance liquid chromatography/tandem mass spectrometry. Results Twelve patients (60%) developed TiPN: 33.3% were symptomatic and 66.6% asymptomatic. Half of this latter group developed coasting effect (TiPN symptoms 1-3 months after drug withdrawal). The main predictive factors for TiPN were treatment duration >= 6 months (p = 0.025) and cumulative dose (p = 0.023). No difference in plasma thalidomide levels between patients with/without TiPN was observed (p = 0.464). After drug withdrawal, 75% symptomatic TiPN patients improved their symptoms. Seven TiPN patients underwent an additional NCS after drug withdrawal: 42.8% worsened NCS, 14.2% was stable, and 42.8% had improved NCS. Conclusion Our data provides novel evidence of coasting effect in half of asymptomatic patients with TiPN. The irreversible nature of this lesion in 25% of TiPN patients reinforces the relevance of early NCS monitoring, and suggests thalidomide use solely as a bridge for other effective therapy for refractory cutaneous lupus patients. (AU)

• Processo FAPESP: 15/03756-4 - Avaliação da relevância dos níveis sanguíneos de drogas utilizadas em doenças autoimunes reumatológicas no acompanhamento da segurança, eficácia e aderência à terapêutica
• Beneficiário: Eloisa Silva Dutra de Oliveira Bonfá
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 19/17272-0 - Avaliação da relevância dos níveis sanguíneos de drogas utilizadas em doenças autoimunes reumatológicas no acompanhamento da segurança, eficácia e aderência à terapêutica
• Beneficiário: Leonard de Vinci Kanda Kupa
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 17/14352-7 - Avaliação da relevância dos níveis sanguíneos de drogas utilizadas em doenças autoimunes reumatológicas no acompanhamento da segurança, eficácia e aderência à terapêutica
• Beneficiário: Tatiana Do Nascimento Pedrosa
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado