Section Review Pulmonary-Allergy, Dermatological, Gastrointestinal & Arthritis: Thalidomide in autoimmune conditions

Abstract

Thalidomide remains a household name 35 years after the disaster caused by its teratogenic properties. Its use re-emerged when the therapeutic benefit of thalidomide in lepromatous leprosy was recognised, and it continues to be used in a small number of patients with a variety of conditions for whom there is no therapeutic alternative. Thalidomide's unique and numerous pharmacological properties have maintained research interest, most recently concentrating on the inhibition of both tumour necrosis factor and angiogenesis. These may be important pharmacological mechanisms in those clinical conditions where it has proven therapeutic benefit. Thalidomide is beneficial in idiopathic oral and genital ulceration, and the similar ulceration of Behçet's disease and human immunodeficiency virus (HIV) infection. In addition, it is of value in chronic graft-versus-host disease, lepromatous leprosy and in a number of rare dermatoses. However, the current use of thalidomide is overshadowed by the tragedy of around 12,000 children affected by its teratogenic potential between 1959–1961. The use of thalidomide must, therefore, be limited to patients who have failed on alternative therapies, and must always promote the safest possible use of this valuable therapeutic agent.

Key Words:

• thalidomide
• autoimmune
• graft-versus-host
• disease
• human immunodeficiency virus
• tumour necrosis factor
• angiogenesis