These authors contributed equally to data collection, analysis and to the writing of this article.
Thalidomide in luminal and fistulizing Crohn's disease resistant to standard therapies
Article first published online: 8 JAN 2007
Alimentary Pharmacology & Therapeutics
Volume 25, Issue 5, pages 557–567, March 2007
How to Cite
PLAMONDON, S., NG, S. C. and KAMM, M. A. (2007), Thalidomide in luminal and fistulizing Crohn's disease resistant to standard therapies. Alimentary Pharmacology & Therapeutics, 25: 557–567. doi: 10.1111/j.1365-2036.2006.03239.x
- Issue published online: 8 JAN 2007
- Article first published online: 8 JAN 2007
- Publication data Submitted 25 September 2006 First decision 10 October 2006 Resubmitted 19 December 2006 Accepted 19 December 2006
Background Thalidomide has been shown to be an effective treatment in Crohn's disease.
Aim To assess the efficacy and tolerability of thalidomide in refractory Crohn's disease patients.
Methods Twenty-five patients were treated. Retrospective ‘estimated’ Crohn's Disease Activity Indices were assessed at baseline and at the end of follow-up. Clinical response was defined as symptomatic improvement and a reduction in the ‘estimated’ Crohn's Disease Activity Index of >100 points, ≥50% reduction in draining fistulas or clinical improvement in perianal ulcers. Clinical remission was defined as symptom resolution and an ‘estimated’ Crohn's Disease Activity Index <150, complete fistula closure or complete ulcer healing.
Results Six of eight patients treated for luminal disease responded to thalidomide at a median follow-up of 12 months (three clinical responses, three clinical remissions). The median reduction in ‘estimated’ Crohn's Disease Activity Index was 212 points (P = 0.005). Nine of 11 patients with active fistulizing disease responded to thalidomide (six responses; three remissions). The four patients treated for both luminal and fistulizing disease had fistula response. Three of them had a response in luminal disease activity. One of two patients with ulcerating perianal disease responded. Twelve patients discontinued treatment because of adverse effects (three sedation; two abdominal pain; one leucopoenia; six neuropathy).
Conclusion Thalidomide is an effective short- to medium-term treatment in selected patients with refractory luminal and fistulizing Crohn's disease. Its long-term use is limited by toxicity.