One-year prospective nerve conduction study of thalidomide neuropathy in lupus erythematosus: Incidence, coasting effect and drug plasma levels

Autor:	Eloisa Bonfa, Nadia E. Aikawa, Léonard de Vinci Kanda Kupa, Tatiana do Nascimento Pedrosa, Clovis A. Silva, Emily Figueiredo Neves Yuki, Ricardo Romiti, Marcelo Arnone, Sandra Gofinet Pasoto, Carlos Otto Heise, Renata Alonso Gadi Soares
Rok vydání:	2021
Předmět:	Adult Male Drug medicine.medical_specialty media_common.quotation_subject Gastroenterology 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Rheumatology Internal medicine Lupus Erythematosus Cutaneous Humans Lupus Erythematosus Systemic Medicine Prospective Studies Prospective cohort study media_common 030203 arthritis & rheumatology Lupus erythematosus medicine.diagnostic_test business.industry Incidence Incidence (epidemiology) Peripheral Nervous System Diseases Plasma levels Middle Aged medicine.disease Thalidomide Treatment Outcome Peripheral neuropathy Withholding Treatment Nerve conduction study Female business medicine.drug
Zdroj:	Lupus. 30:956-964
ISSN:	1477-0962 0961-2033
DOI:	10.1177/0961203321998433
Popis:	Background Few prospective studies in cutaneous and systemic lupus erythematosus (CLE/SLE) assessed thalidomide-induced peripheral neuropathy (TiPN) incidence/reversibility, and most have not excluded confounding causes neither monitored thalidomide plasma levels. Objectives To evaluate TiPN incidence/reversibility, coasting effect and its association with thalidomide plasma levels in CLE/SLE. Methods One-year prospective study of thalidomide in 20 CLE/SLE patients without pregnancy potential, with normal nerve conduction study (NCS), and excluded other PN causes. Thalidomide levels were determined by high-performance liquid chromatography/tandem mass spectrometry. Results Twelve patients (60%) developed TiPN: 33.3% were symptomatic and 66.6% asymptomatic. Half of this latter group developed coasting effect (TiPN symptoms 1-3 months after drug withdrawal). The main predictive factors for TiPN were treatment duration ≥6 months (p = 0.025) and cumulative dose (p = 0.023). No difference in plasma thalidomide levels between patients with/without TiPN was observed (p = 0.464). After drug withdrawal, 75% symptomatic TiPN patients improved their symptoms. Seven TiPN patients underwent an additional NCS after drug withdrawal: 42.8% worsened NCS, 14.2% was stable, and 42.8% had improved NCS. Conclusion Our data provides novel evidence of coasting effect in half of asymptomatic patients with TiPN. The irreversible nature of this lesion in 25% of TiPN patients reinforces the relevance of early NCS monitoring, and suggests thalidomide use solely as a bridge for other effective therapy for refractory cutaneous lupus patients.
Databáze:	OpenAIRE
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