Thalidomide Helpful in Refractory Ankylosing Spondylitis

[Guest guest]

Thalidomide Helpful in Refractory Ankylosing Spondylitis

NEW YORK (Reuters Health) Jan 12 - Thalidomide treatment appears useful in

patients with severe ankylosing spondylitis (AS) refractory to conventional

therapy, according to researchers in China and Taiwan. After 5 of 13

patients dropped out of the study, 4 of the 8 who completed a course of

treatment showed a greater than 50% improvement and the other 4 showed an

improvement of more than 20%.

Dr. Cheng-Chung Wei of Chung Shan Medical University, Taichung, Taiwan

and colleagues note that therapies targeting tumor necrosis factor (TNF)

alpha have shown dramatic results in patients with refractory AS. However,

these biological modifying agents such as infliximab " are expensive and not

available in many countries. "

Thalidomide also inhibits TNF alpha, and the researchers sought to examine

its effect in 13 patients with refractory AS. Three had juvenile AS, 9 had

adult AS and the remaining patient had AS with psoriasis.

Subjects were given thalidomide 100 mg per day for a week followed by 200 mg

per day for a further 24 weeks.

Two patients withdrew from the study because they developed severe rashes,

one did so because of dizziness and a further 2 dropped out because they

experienced no treatment effect after 8 weeks.

There were significant improvements in measures of function and disease

activity and a significant improvement in eosinophil sedimentation rate.

Minor adverse events such as dizziness and constipation were seen in most

patients, but there were no serious adverse events. The researchers observe

that " specific TNF-alpha antagonists are not available or affordable in most

Asian countries. " Thalidomide, they conclude " is a viable alternative. "

J Rheumatol 2003;30:2627-2631.