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Date: Mon, 26 Jan 2004 16:51:54 -1000

From: Georgina <gmckin@...>

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Thalidomide Helpful in Refractory Ankylosing Spondylitis

J Rheumatol 2003;30:2627-2631.

http://www.medscape.com/viewarticle/467079?mpid=23730

NEW YORK (Reuters Health) Jan 12 - Thalidomide treatment appears useful

in patients with severe ankylosing spondylitis (AS) refractory to

conventional therapy, according to researchers in China and Taiwan.

After 5 of 13 patients dropped out of the study, 4 of the 8 who

completed a course of treatment showed a greater than 50% improvement

and the other 4 showed an improvement of more than 20%.

Dr. Cheng-Chung Wei of Chung Shan Medical University, Taichung,

Taiwan and colleagues note that therapies targeting tumor necrosis

factor (TNF) alpha have shown dramatic results in patients with

refractory AS. However, these biological modifying agents such as

infliximab " are expensive and not available in many countries. "

Thalidomide also inhibits TNF alpha, and the researchers sought to

examine its effect in 13 patients with refractory AS. Three had juvenile

AS, 9 had adult AS and the remaining patient had AS with psoriasis.

Subjects were given thalidomide 100 mg per day for a week followed by

200 mg per day for a further 24 weeks.

Two patients withdrew from the study because they developed severe

rashes, one did so because of dizziness and a further 2 dropped out

because they experienced no treatment effect after 8 weeks.

There were significant improvements in measures of function and disease

activity and a significant improvement in eosinophil sedimentation rate.

Minor adverse events such as dizziness and constipation were seen in

most patients, but there were no serious adverse events. The researchers

observe that " specific TNF-alpha antagonists are not available or

affordable in most Asian countries. " Thalidomide, they conclude " is a

viable alternative. "