Thalidomide and Lenalidomide for Refractory Systemic/Cutaneous Lupus Erythematosus Treatment A Narrative Review of Literature for Clinical Practice

Autor(es)

Neves Yuki, Emily Figueiredo ^[1] ; Silva, Clovis A. ^[1] ; Aikawa, Nadia E. ^[1] ; Romiti, Ricardo ^[2] ; Heise, Carlos Otto ^[3] ; Bonfa, Eloisa ^[1] ; Pasoto, Sandra Gofinet ^[1]

Afiliação do(s) autor(es)

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

^[2] Univ Sao Paulo HCFMUSP, Dept Dermatol, Fac Med, Hosp Clin, Sao Paulo - Brazil

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

• Tipo de documento: Artigo de Revisão
• Fonte: JCR-JOURNAL OF CLINICAL RHEUMATOLOGY; v. 27, n. 6, p. 248-259, SEP 2021.
• Citações Web of Science: 2

Resumo

Background: Thalidomide has shown exceptional results in systemic/cutaneous lupus erythematosus(SLE/CLE). Recently, lenalidomide has been also prescribed for SLE/CLE treatment. Literature regarding efficacy/adverse events for these drugs is scarce with a single systematic review and meta-analysis focused solely on thalidomide for refractory cutaneous lupus subtypes. Objective: We, therefore, addressed in this narrative review the efficacy/adverse effects of thalidomide and lenalidomide for SLE and CLE. In addition, we provide a specialist approach for clinical practice based on the available evidence. Results: Efficacy of thalidomide for refractory cutaneous lupus treatment was demonstrated by several studies, mostly retrospective with small sample size(<= 20). The frequency of peripheral polyneuropathy is controversial varying from 15-80% with no consistent data regarding cumulative dose and length of use. Drug withdrawn results in clinical partial/complete reversibility for most cases (70%). For lenalidomide, seven studies (small sample sizes) reported its efficacy for SLE/CLE with complete/partial response in all patients with a mean time to response of 3 months. Flare rate varied from 25-75% occurring 0.5-10 months after drug withdrawn. There were no reports of polyneuropathy/worsening of previous thalidomide-induced neuropathy, but most of them did not perform nerve conduction studies. Teratogenicity risk exist for both drugs and strict precautions are required. Conclusions: Thalidomide is very efficacious as an induction therapy for patients with severe/refractory cutaneous lupus with high risk of scarring, but its longstanding use should be avoided due to neurotoxicity. Lenalidomide is a promising drug for skin lupus treatment, particularly regarding the apparent lower frequency of nerve side effects. (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