Sunday, July 6, 2014

Thalidomide and Crohn's (An Update): 3 Patients in Remission Long Term Study

I wrote this blog post about thalidomide a while ago and it seems as if now thalidomide may possibly be a treatment for Crohn's. This recent study in the July 2014 edition of Journal of Clinical Gastroenterology (if you want something to read before bed) found 3 patients who took thalidomide. All patients achieved a complete clinical remission and showed endoscopic evidence of healing. The dosage amount that patients took was between 50 and 150 mg/d. Treatment ranged from 4-8 years (which is very long for a clinical trial). 2 patients had perianal fistuals and the other patient had upper gastrointestinal Crohn's lesions and an inflammatory ileocolonic stricture. There were some side effects such as drowsiness, peripheral neuropathy. Peripheral neuropathy was reported in half of the patients (however is reversible once the medication is stopped). The rule seems to be once patients have a cumulative dosage of 50 grams of thalidomide then neuropathy occurs. Patients also have to be careful in not trying to conceive during the treatment or 6 months after ending the drug.

In the same issue of Journal of Clinical Gastroenterology is a letter from someone discussing the possible future for thalidomide. In one study with 12 male patients who had low doses of thalidomide (50-100 mg) daily 70% of patients had a response with 20% getting to remission in 3 months. In another study however when the dosage was increased to 300 mg each night 75% of patients responded within 1 month and 40% were in remission by 3 months. In a multicenter, double blind, placebo controlled (these types of studies are considered the gold standard when doing clinical trials) in 56 children showed that 46% of children achieved remission compared to a 12% placebo. The patients who were given the placebo were given thalidomide 52% of these patients achieved remission.

Thalidomide which was thought of as one of the worse drugs ever created caused some serious birth defects for women that took the drug. These days thalidomide is making a come back and is used to treat a wide range of diseases such as multiple myeloma, cancers, HIV, rheumatoid arthritis. Now it looks like Crohn's may have a role for Crohn's patients especially for patients that are having a flare up for a short period of time. Also patients who are older with Crohn's would benefit since they are not likely to conceive. I hope more studies can be done to show how this drug could help many people.  

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