A possible mechanism of action of thalidomide on rheumatoid arthritis

Treatment of severe colitis in Behçet's syndrome with thalidomide (CG-217)

A 35-year-old male patient, known in our department since 1979 on account of a severe and complete Behçet's syndrome, was treated with thalidomide (CG-217) as a final pharmacological measure to avoid colectomy during a severe attack of Behçet colitis. Prior to the administration of thalidomide, the patient had been treated for 7 weeks with full parenteral nutrition and high doses of steroids intravenously without a satisfactory effect on the colitis. Treatment with sulphasalazin was unsuccessful because of a decreasing number of platelets on this drug. After a few days on thalidomide, 300 mg given once daily at bedtime, the patient's stools were normalized and without reaction for blood, his oral ulcers and pleural effusion disappeared, and his steroid doses could be reduced. Gradually he was put on oral nutrition again, and his rectal mucosa became normalized. The dose of thalidomide was reduced to 200 mg, and then to 100 mg daily when the patient was discharged from hospital, less than 3 weeks after institution of the drug treatment. After 5 months as an out-patient his condition is still satisfactory and without symptoms of his former disease. Thalidomide has previously been reported to be of value in treatment of Behçet's syndrome, but to my knowledge never with such a dramatic effect on a severe colitis as reported in this case.

Treatment of Behçet's disease with thalidomide

The clinical response to thalidomide in 30 male patients with Behçet's disease was reviewed. Twenty-six patients with orogenital ulcerations responded (20 completely and 6 partially). Cutaneous lesions including erythema nodosum or necrotic pseudofolliculitis were controlled by treatment in the majority of cases. All patients with arthritis responded (13 completely and 1 partially). Uveitis was improved in 3 patients, stabilizated in 4 and aggravated in 4. Patients with thalidomide purposely discontinued experienced a flare; the reintroduction of therapy controlled the flare. Side effects were uncommon and included skin rash and somnolence. These results suggest that thalidomide may be useful in the therapy of the various manifestations of Behçet's disease and that a controlled study is indicated.