Volume 72, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In a randomized, double-blind, double-dummy controlled study, 22 men with erythema nodosum leprosum (ENL) received six capsules containing either 100 mg (group A, n = 12) or 300 mg (group B, n = 10) of thalidomide daily for one week. A six-week, four capsules per day taper followed, in which group A received 50 mg/day of thalidomide in weeks 2 and 3, then dummy capsules in weeks 4 through 7, while group B had gradual decrements every two weeks. Both regimens caused comparable improvement in 19 patients at day 7 (group A [12 of 12] versus group B [7 of 10]; = 0.08), but slower tapering in group B showed less re-emergence of ENL through week 7 ( = 0.02, versus group A). Most patients developed new lesions soon after stopping treatment. Slower tapering from a higher initial thalidomide dose may improve clinical ENL responses, but high recurrence rates after discontinuation indicates further assessment is needed to identify better tapering regimens.


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  1. Britton WJ, Lockwood DN, 2004. Leprosy. Lancet 363 : 1209–1219. [Google Scholar]
  2. Sehgal VN, 1994. Leprosy. Dermatol Clin 12 : 629–644. [Google Scholar]
  3. Mellin G, Kalzenstein M, 1962. The saga of thalidomide: neuropathy to embryopathy with case reports of congenital anomalies. New Engl J Med 267 : 1184–1244. [Google Scholar]
  4. Sheskin J, 1965. Thalidomide in the treatment of lepra reactions. Clin Pharmacol Ther 6 : 303–306. [Google Scholar]
  5. Hastings RC, Trautman JR, Enna CD, Jacobson RR, 1970. Thalidomide in the treatment of erythema nodosum leprosum. With a note on selected laboratory abnormalities in erythema nodosum leprosum. Clin Pharmacol Ther 11 : 481–487. [Google Scholar]
  6. Iyer CG, Languillon J, Ramanujam K, Tarabini-Castellani G, Delas-Aguas JT, Bechelli LM, Uemura K, Martinez-Dominguez V, Sundaresan T, 1971. WHO co-ordinated short-term double-blind trial with thalidomide in the treatment of acute lepra reactions in male lepromatous patients. Bull World Health Organ 45 : 719–732. [Google Scholar]
  7. Pearson JM, Vedagiri M, 1969. Treatment of moderately severe erythema nodosum leprosum with thalidomide—a double-blind controlled trial. Lepr Rev 40 : 111–116. [Google Scholar]
  8. Sheskin J, Convit J, 1969. Results of a double blind study of the influence of thalidomide on the lepra reaction. Int J Lepr Other Mycobact Dis 37 : 135–146. [Google Scholar]
  9. Waters MF, 1971. An internally-controlled double blind trial of thalidomide in severe erythema nodosum leprosum. Lepr Rev 42 : 26–42. [Google Scholar]
  10. Stirling DI, 1998. Thalidomide and its impact in dermatology. Semin Cutan Med Surg 17 : 231–242. [Google Scholar]
  11. Sheskin J, 1980. The treatment of lepra reaction in lepromatous leprosy. Fifteen years’ experience with thalidomide. Int J Dermatol 19 : 318–322. [Google Scholar]
  12. Dredge K, Marriott JB, Dalgleish AG, 2002. Immunological effects of thalidomide and its chemical and functional analogs. Crit Rev Immunol 22 : 425–437. [Google Scholar]
  13. Varricchio F, Iskander J, Destefano F, Ball R, Pless R, Braun MM, Chen RT, 2004. Understanding vaccine safety information from the Vaccine Adverse Event Reporting System. Pediatr Infect Dis J 23 : 287–294. [Google Scholar]
  14. Pichyangkul S, Yongvanitchit K, Kumarb U, Krieg AM, Heppner DG, Walsh DS, 2001. Whole blood cultures to assess the immunostimulatory activities of CpG oligodeoxynucleotides. J Immunol Methods 247 : 83–94. [Google Scholar]
  15. Brown AE, Webster HK, Teja-Isavadharm P, Keeratithakul D, 1990. Macrophage activation in falciparum malaria as measured by neopterin and interferon-gamma. Clin Exp Immunol 82 : 97–101. [Google Scholar]
  16. Cellona RV, Balagon MF, dela Cruz EC, Burgos JA, Abalos RM, Walsh GP, Topolski R, Gelber RH, Walsh DS, 2003. Long-term efficacy of 2 year WHO multiple drug therapy (MDT) in multibacillary (MB) leprosy patients. Int J Lepr Other Mycobact Dis 71 : 308–319. [Google Scholar]
  17. Villahermosa LG, Fajardo TT Jr, Abalos RM, Cellona RV, Balagon MV, dela Cruz EC, Tan EV, Walsh GP, Walsh DS, 2004. Parallel assessment of 24 monthly doses of rifampin, ofloxacin, and minocycline versus two years of World Health Organization multi-drug therapy for multi-bacillary leprosy. Am J Trop Med Hyg 70 : 197–200. [Google Scholar]
  18. Cazort RJ, Ye Kun S, 1966. A trial of thalidomide in progressive lepra reactions. Curr Ther Res Clin Exp 8 : 299–311. [Google Scholar]
  19. Levy L, Fasal P, Levan NE, Freedman RI, 1973. Treatment of erythema nodosum leprosum with thalidomide. Lancet 2 : 324–325. [Google Scholar]
  20. Williams I, Weller IV, Malni A, Anderson J, Waters MF, 1991. Thalidomide hypersensitivity in AIDS. Lancet 337 : 436–437. [Google Scholar]
  21. Rea TH, 2001. Decreases in mean hemoglobin and serum albumin values in erythema nodosum leprosum and lepromatous leprosy. Int J Lepr Other Mycobact Dis 69 : 318–327. [Google Scholar]
  22. Rea TH, 2002. Elevated platelet counts and thrombocytosis in erythema nodosum leprosum. Int J Lepr Other Mycobact Dis 70 : 167–173. [Google Scholar]
  23. Somers GF, 1960. Pharmacological properties of thalidomide (alpha-phthalimido glutarimide), a new sedative hypnotic drug. Br Pharm Chemother 15 : 111–116. [Google Scholar]
  24. Sampaio EP, Kaplan G, Miranda A, Nery JA, Miguel CP, Viana SM, Sarno EN, 1993. The influence of thalidomide on the clinical and immunologic manifestation of erythema nodosum leprosum. J Infect Dis 168 : 408–414. [Google Scholar]
  25. Sampaio EP, Moreira AL, Sarno EN, Malta AM, Kaplan G, 1992. Prolonged treatment with recombinant interferon gamma induces erythema nodosum leprosum in lepromatous leprosy patients. J Exp Med 175 : 1729–1737. [Google Scholar]
  26. Moreira AL, Kaplan G, Villahermosa LG, Fajardo TJ, Abalos RM, Cellona RV, Balagon MV, Tan EV, Walsh GP, 1998. Comparison of pentoxifylline, thalidomide and prednisone in the treatment of ENL. Int J Lepr Other Mycobact Dis 66 : 61–65. [Google Scholar]
  27. Hamerlinck FF, Klatser PR, Walsh DS, Bos JD, Walsh GP, Faber WR, 1999. Serum neopterin as a marker for reactional states in leprosy. FEMS Immunol Med Microbiol 24 : 405–409. [Google Scholar]
  28. Haslett PA, Corral LG, Albert M, Kaplan G, 1998. Thalidomide costimulates primary human T lymphocytes, preferentially inducing proliferation, cytokine production, and cytotoxic responses in the CD8+ subset. J Exp Med 187 : 1885–1892. [Google Scholar]
  29. Shannon EJ, Sandoval F, 1995. Thalidomide increases the synthesis of IL-2 in cultures of human mononuclear cells stimulated with concanavalin-A, staphylococcal enterotoxin A, and purified protein derivative. Immunopharmacology 31 : 109–116. [Google Scholar]
  30. Marriott JB, Dredge K, Dalgleish AG, 2003. Thalidomide derived immunomodulatory drugs (IMiDs) as potential therapeutic agents. Curr Drug Targets Immune Endocr Metabol Disord 3 : 181–186. [Google Scholar]

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  • Received : 29 Aug 2004
  • Accepted : 08 Dec 2004

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