No drug anywhere is more infamous than thalidomide. Originally a tranquilizer frequently given to women, the drug caused a large number of horrible birth defects. That ended its use -- until scientists found that thalidomide can dampen harmful immune reactions.
It's been known since 1975 that thalidomide treatment helps the severe skin rash seen in some lupus patients. But since there are other drugs, few doctors now risk using the drug. That's all well and good -- except that these drugs don't work for all patients, and sometimes they stop working.
Now Tamara Salam Housman, MD, and colleagues at Wake Forest University in Winston-Salem, N.C., show that a relatively low, 100 mg dose of thalidomide works when other agents have failed. They gave the drug to 23 patients whose skin lupus didn't get better after conventional treatment.
Seventeen of the 23 patients got completely better. Three patients had 75% or better improvement. And 91% of the time, these improvements came within eight weeks of starting thalidomide treatment.
"We believe that low-dose thalidomide ... has earned a niche on the therapeutic ladder in the management of these [treatment-resistant lupus rashes]," Housman and colleagues write in the January 2003 issue of the Archives of Dermatology.
Because of its dangers, patients who take thalidomide -- and their doctors and pharmacists -- must follow stringent rules for counseling, monitoring, birth control, pregnancy testing, and prescribing. Housman and colleagues argue that these rules should be eased for dermatologists who prescribe thalidomide for lupus patients. They say these doctors already have experience in safely prescribing other drugs that cause birth defects, such as Accutane for acne.