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Título: Thalidomide and Lenalidomide for Refractory Systemic/Cutaneous Lupus Erythematosus Treatment A Narrative Review of Literature for Clinical Practice
Autor(es): YUKI, Emily Figueiredo NevesSILVA, Clovis A.AIKAWA, Nadia E.ROMITI, RicardoHEISE, Carlos OttoBONFA, EloisaPASOTO, Sandra Gofinet
Parte de: JCR-JOURNAL OF CLINICAL RHEUMATOLOGY, v.27, n.6, p.248-259, 2021
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 Drug withdrawn results in clinical partial/complete reversibility for most cases (70%).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 Flare rate varied from 25-75% occurring 0.5-10 months after drug withdrawn.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.
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Artigos e Materiais de Revistas Científicas - FM/MCM
Departamento de Clínica Médica - FM/MCM

Artigos e Materiais de Revistas Científicas - FM/MPE
Departamento de Pediatria - FM/MPE

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Instituto Central - HC/ICHC

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Instituto de Ortopedia e Traumatologia - HC/IOT

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LIM/03 - Laboratório de Medicina Laboratorial

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LIM/15 - Laboratório de Investigação em Neurologia

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LIM/17 - Laboratório de Investigação em Reumatologia

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LIM/36 - Laboratório de Pediatria Clínica

Artigos e Materiais de Revistas Científicas - LIM/50
LIM/50 - Laboratório de Patologia das Moléstias Infecciosas

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