A RANDOMIZED, DOUBLE-BLIND, DOUBLE-DUMMY, CONTROLLED DOSE COMPARISON OF THALIDOMIDE FOR TREATMENT OF ERYTHEMA NODOSUM LEPROSUM

LAARNI G. VILLAHERMOSA Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by LAARNI G. VILLAHERMOSA in
Current site
Google Scholar
PubMed
Close
,
TRANQUILINO T. FAJARDO JR Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by TRANQUILINO T. FAJARDO JR in
Current site
Google Scholar
PubMed
Close
,
RODOLFO M. ABALOS Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by RODOLFO M. ABALOS in
Current site
Google Scholar
PubMed
Close
,
MARIA V. BALAGON Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by MARIA V. BALAGON in
Current site
Google Scholar
PubMed
Close
,
ESTERLINA V. TAN Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by ESTERLINA V. TAN in
Current site
Google Scholar
PubMed
Close
,
ROLAND V. CELLONA Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by ROLAND V. CELLONA in
Current site
Google Scholar
PubMed
Close
,
JEFFREY P. PALMER Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by JEFFREY P. PALMER in
Current site
Google Scholar
PubMed
Close
,
JANET WITTES Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by JANET WITTES in
Current site
Google Scholar
PubMed
Close
,
STEVEN D. THOMAS Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by STEVEN D. THOMAS in
Current site
Google Scholar
PubMed
Close
,
KARIN A. KOOK Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by KARIN A. KOOK in
Current site
Google Scholar
PubMed
Close
,
GERALD P. WALSH Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by GERALD P. WALSH in
Current site
Google Scholar
PubMed
Close
, and
DOUGLAS S. WALSH Leonard Wood Memorial Center for Leprosy Research (American Leprosy Foundation) Cebu City, The Philippines; Statistics Collaborative, Inc., Washington, District of Columbia; Celgene Corporation, Warren, New Jersey; Salamandra, Inc., Bethesda, Maryland; Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, Georgia

Search for other papers by DOUGLAS S. WALSH in
Current site
Google Scholar
PubMed
Close
Restricted access

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]; P = 0.08), but slower tapering in group B showed less re-emergence of ENL through week 7 (P = 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.

Author Notes

Reprint requests: Douglas S. Walsh, Dermatology Service, Eisenhower Army Medical Center, Fort Gordon, GA 30905, Telephone: 706-787-1472, Fax: 706-787-1354, E-mail: douglas.walsh@se.amedd.army.mil.
  • 1

    Britton WJ, Lockwood DN, 2004. Leprosy. Lancet 363 :1209–1219.

  • 2

    Sehgal VN, 1994. Leprosy. Dermatol Clin 12 :629–644.

  • 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.

    • Search Google Scholar
    • Export Citation
  • 4

    Sheskin J, 1965. Thalidomide in the treatment of lepra reactions. Clin Pharmacol Ther 6 :303–306.

  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 9

    Waters MF, 1971. An internally-controlled double blind trial of thalidomide in severe erythema nodosum leprosum. Lepr Rev 42 :26–42.

    • Search Google Scholar
    • Export Citation
  • 10

    Stirling DI, 1998. Thalidomide and its impact in dermatology. Semin Cutan Med Surg 17 :231–242.

  • 11

    Sheskin J, 1980. The treatment of lepra reaction in lepromatous leprosy. Fifteen years’ experience with thalidomide. Int J Dermatol 19 :318–322.

    • Search Google Scholar
    • Export Citation
  • 12

    Dredge K, Marriott JB, Dalgleish AG, 2002. Immunological effects of thalidomide and its chemical and functional analogs. Crit Rev Immunol 22 :425–437.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 18

    Cazort RJ, Ye Kun S, 1966. A trial of thalidomide in progressive lepra reactions. Curr Ther Res Clin Exp 8 :299–311.

  • 19

    Levy L, Fasal P, Levan NE, Freedman RI, 1973. Treatment of erythema nodosum leprosum with thalidomide. Lancet 2 :324–325.

  • 20

    Williams I, Weller IV, Malni A, Anderson J, Waters MF, 1991. Thalidomide hypersensitivity in AIDS. Lancet 337 :436–437.

  • 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.

    • Search Google Scholar
    • Export Citation
  • 22

    Rea TH, 2002. Elevated platelet counts and thrombocytosis in erythema nodosum leprosum. Int J Lepr Other Mycobact Dis 70 :167–173.

  • 23

    Somers GF, 1960. Pharmacological properties of thalidomide (alpha-phthalimido glutarimide), a new sedative hypnotic drug. Br Pharm Chemother 15 :111–116.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 29 29 4
Full Text Views 330 92 0
PDF Downloads 124 22 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save