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An observational analysis of low-dose thalidomide in recalcitrant prurigo nodularis.
Clin Exp Dermatol. 2019 May 27;:
Authors: Sardana K, Gupta A, Sinha S
Abstract
Thalidomide has been used as an effective treatment for prurigo nodularis (PN) with a median dose of 200 mg, but the risk of peripheral neuropathy precludes long-term use. We analysed the efficacy of low-dose thalidomide (< 100 mg) in 17 patients with recalcitrant PN. Patients were initiated on thalidomide 50 mg alternate daily, and the dose was increased (doubled) in a stepwise manner, if needed, until a ≥ 50% reduction in score (partial response; PR) on a visual analogue scale (VAS) was achieved. Thalidomide then was continued at the same dose for 4 weeks to achieve ≥ 90% decrease in VAS score; if this was not achieved, the dose was increased to a maximum of 100 mg and continued until complete resolution of lesions (complete response; CR). Four patients discontinued thalidomide due to adverse effects. Four patients achieved PR, while 9 patients (n = 2 with 50mg, n = 7 with 100mg) achieved CR. No patient developed neuropathy. In addition, complete responders achieved an earlier ≥ 50% reduction in VAS score. Two patients relapsed after 12 months but responded to thalidomide 50 mg. Prurigo nodularis (PN) is a distinctive reaction pattern to incessant scratching due to various predisposing factors. Studies have shown an increase in nerve fibre density with increased expression of nerve growth factor and its receptor, tyrosine kinase A, along with the release and accumulation of neuropeptides such as substance P and calcitonin gene-related peptide, suggesting a role of agents working at the neural level in the management of PN.1 T-helper (Th)2 cytokines and interleukin (IL)-31 have also been implicated in the pathogenesis of PN. Thalidomide acts as an antipruritic agent owing to its central depressant, anti-inflammatory and neuromodulatory effects, and has been found to be effective for PN with a median dose of 200 mg.2 However, this dose can lead to adverse effects (AEs), preventing long-term use. There are conflicting reports on the use of low-dose thalidomide for the treatment of PN (Table 1).3-8 We analysed our experience of the efficacy and relapse rates of low-dose thalidomide (< 100 mg) in patients with recalcitrant PN. This article is protected by copyright. All rights reserved.
Thalidomide has been used as an effective treatment for prurigo nodularis (PN) with a median dose of 200 mg, but the risk of peripheral neuropathy precludes long-term use. We analysed the efficacy of low-dose thalidomide (< 100 mg) in 17 patients with recalcitrant PN. Patients were initiated on thalidomide 50 mg alternate daily, and the dose was increased (doubled) in a stepwise manner, if needed, until a ≥ 50% reduction in score (partial response; PR) on a visual analogue scale (VAS) was achieved. Thalidomide then was continued at the same dose for 4 weeks to achieve ≥ 90% decrease in VAS score; if this was not achieved, the dose was increased to a maximum of 100 mg and continued until complete resolution of lesions (complete response; CR). Four patients discontinued thalidomide due to adverse effects. Four patients achieved PR, while 9 patients (n = 2 with 50mg, n = 7 with 100mg) achieved CR. No patient developed neuropathy. In addition, complete responders achieved an earlier ≥ 50% reduction in VAS score. Two patients relapsed after 12 months but responded to thalidomide 50 mg. Prurigo nodularis (PN) is a distinctive reaction pattern to incessant scratching due to various predisposing factors. Studies have shown an increase in nerve fibre density with increased expression of nerve growth factor and its receptor, tyrosine kinase A, along with the release and accumulation of neuropeptides such as substance P and calcitonin gene-related peptide, suggesting a role of agents working at the neural level in the management of PN.1 T-helper (Th)2 cytokines and interleukin (IL)-31 have also been implicated in the pathogenesis of PN. Thalidomide acts as an antipruritic agent owing to its central depressant, anti-inflammatory and neuromodulatory effects, and has been found to be effective for PN with a median dose of 200 mg.2 However, this dose can lead to adverse effects (AEs), preventing long-term use. There are conflicting reports on the use of low-dose thalidomide for the treatment of PN (Table 1).3-8 We analysed our experience of the efficacy and relapse rates of low-dose thalidomide (< 100 mg) in patients with recalcitrant PN. This article is protected by copyright. All rights reserved.
PMID: 31132160 [PubMed - as supplied by publisher]
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