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Long‐term outcomes of thalidomide in refractory Crohn's disease
Author(s) -
Gerich M. E.,
Yoon J. L.,
Targan S. R.,
Ippoliti A. F.,
Vasiliauskas E. A.
Publication year - 2015
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13057
Subject(s) - medicine , thalidomide , refractory (planetary science) , crohn's disease , adverse effect , retrospective cohort study , gastroenterology , surgery , abdominal pain , inflammatory bowel disease , disease , astrobiology , multiple myeloma , physics
Summary Background Several open‐label and retrospective studies have indicated that thalidomide may be beneficial in patients with refractory Crohn's disease ( CD ). Aim To report our long‐term experience with the use of thalidomide for adults with refractory Crohn's disease. Methods We conducted a retrospective study of long‐term clinical and safety outcomes among adults treated with thalidomide for refractory Crohn's disease. Response was defined as a clinician's assessment of improvement after at least 7 days treatment of one or more of the following: bowel movement frequency, fistula output, rectal bleeding, abdominal pain, extraintestinal manifestations, or well‐being. Remission required all of the following: <3 stools/day, no bleeding, abdominal pain or extraintestinal manifestations and increased well‐being. Results Thirty‐seven adults with refractory Crohn's disease were treated with thalidomide for a median of 4.4 months and followed up for a median of 58 months. Clinical response and remission rates were 54% and 19%, respectively. About 40% of patients were able to stop steroids. Response rates were higher for those treated with more than 50 mg/day (85%) than for those treated with a maximum of 50 mg/day (40%; P = 0.01). An adverse event occurred in 68% of patients. Approximately one‐third of patients (38%) experienced neuropathy. Conclusions Thalidomide appears to be safe and effective in some patients with refractory Crohn's disease. Although side effects may limit long‐term use, thalidomide has potential to induce significant clinical responses.