Thalidomide for treatment of severe intestinal bleeding

Apart from its anti-inflammatory activity, which has been used for the treatment of active Crohn’s disease, thalidomide is also a potent inhibitor of angiogenesis. We therefore studied the effect of thalidomide in six patients with severe recurrent intestinal bleeding refractory to standard treatmen...

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Bibliographic Details
Published in:Gut 2004-04, Vol.53 (4), p.609-612
Main Authors: Bauditz, J, Schachschal, G, Wedel, S, Lochs, H
Format: Article
Language:English
Subjects:
Adult
Aged
Angiogenesis
Angiogenesis Inhibitors - therapeutic use
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Blood transfusions
Care and treatment
Case Report
CDAI
CDEIS
Colorectal diseases
Crohn Disease - complications
Crohn's disease
Crohn’s disease activity index
Crohn’s disease endoscopic index of severity
Endoscopy
Female
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal diseases
Gastrointestinal Hemorrhage - blood
Gastrointestinal Hemorrhage - drug therapy
Gastrointestinal Hemorrhage - etiology
Health aspects
Hospitals
Humans
Inflammation
intestinal bleeding
Male
Medical sciences
Middle Aged
obscure bleeding
Patients
Pharmacology. Drug treatments
Recurrence
Small intestine
Thalidomide
Thalidomide - therapeutic use
Tumors
Vascular endothelial growth factor
Vascular Endothelial Growth Factor A - blood
VEGF
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Summary:Apart from its anti-inflammatory activity, which has been used for the treatment of active Crohn’s disease, thalidomide is also a potent inhibitor of angiogenesis. We therefore studied the effect of thalidomide in six patients with severe recurrent intestinal bleeding refractory to standard treatment (three patients with Crohn’s disease (CD), three patients with obscure intestinal bleeding; mean of 56 blood transfusions within the last 24 months). Bleeding stopped within two weeks after the start of thalidomide in all patients. Haemoglobin normalised without further transfusions for the whole observation period (mean follow up 33 months) while patients needed a mean of 2.2 (CD) and 3.1 (obscure bleeding) blood units/month in the 12 months before treatment. After three months of thalidomide therapy, serum levels of vascular endothelial growth factor were strongly suppressed compared with pretreatment levels. (CD 818 (82) v 129 (86) pg/ml; obscure bleeding 264 (68) v 50 (25) pg/ml). All six patients reported transient fatigue. Peripheral neuropathy was observed in one patient with CD after nine months and was reversible after lowering the dose to 100 mg daily. These results indicate that thalidomide might be useful for patients with otherwise refractory intestinal bleeding.
ISSN:0017-5749
1468-3288
DOI:10.1136/gut.2003.029710