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The clinical implications of thalidomide in inflammatory bowel diseases
Antonella Diamanti1, Teresa Capriati, Bronislava Papadatou
1Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy.
Insights
Thalidomide shows anti-inflammatory benefits for inflammatory bowel diseases (IBD). While not recommended for pediatric Crohn's disease, short-term use may be considered for adults and children, with reversible neuropathy as a potential side effect.
Area of Science:
- Immunology
- Gastroenterology
- Pharmacology
Background:
- Thalidomide exhibits anti-inflammatory and anti-angiogenetic properties beneficial for inflammatory bowel diseases (IBD).
- Current guidelines suggest thalidomide is not recommended for refractory pediatric Crohn's disease but may be considered for specific adult and pediatric patient groups.
- Concerns regarding teratogenicity limit long-term use in young adults, necessitating strict contraceptive measures.
Purpose of the Study:
- To evaluate the efficacy and safety of short-term thalidomide treatment for inflammatory bowel diseases (IBD).
- To review existing data on thalidomide use in adult and pediatric IBD patients.
Main Methods:
- Review of literature and clinical data on thalidomide use in IBD.
- Analysis of reported cases in adult and pediatric populations.
Main Results:
- Thalidomide has been used in 223 adult and pediatric IBD patients, predominantly for Crohn's disease (206 cases).
- Short-term use of thalidomide appears relatively safe.
- Neuropathy is the most common adverse effect, which is reversible in children.
Conclusions:
- Thalidomide's anti-inflammatory and anti-angiogenetic activities suggest potential in IBD treatment.
- Short-term thalidomide therapy may be a viable option for selected IBD patients, particularly those unresponsive to other treatments.
- Careful monitoring for adverse effects, especially neuropathy, is crucial during short-term treatment.
Abstract:
Thalidomide has anti-inflammatory and anti-angiogenetic activity that makes it suitable for treating inflammatory bowel diseases (IBD). The recent guidelines from the European Crohn's and Colitis Organization/European Society for Pediatric Gastroenterology Hepatology and Nutrition conclude that thalidomide cannot be recommended in refractory pediatric Crohn's disease but that it may be considered in selected cohorts of patients who are not anti-TNFα agent responders. The main adverse effect is the potential teratogenicity that renders the long-term use of thalidomide problematic in young adults due to the strict need for contraceptive use. In short-term use it is relatively safe; the most likely adverse effect is the neuropathy, which is highly reversible in children. So far the use of thalidomide is reported in 223 adult and pediatric IBD patients (206 with Crohn's disease). In the following sections, the authors will discuss efficacy and safety of thalidomide, in the short-term treatment of IBD.
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