Respiratory Pathophysiology Section, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.
Biomed Pharmacother. 2012 Jun;66(4):300-7. doi: 10.1016/j.biopha.2012.03.005. Epub 2012 Mar 22.
Limited data report thalidomide improves cutaneous sarcoidosis; no benefit has been reported for pulmonary localization.
To evaluate feasibility and efficacy of prolonged treatment with thalidomide for cutaneous sarcoidosis associated to pulmonary involvement in patients with resistance or contraindications to steroids.
Nineteen patients were treated with thalidomide for 24 months starting with 200 mg/d for first 2 weeks, followed by 100 mg/d for 11 weeks and a maintenance dose of 100mg on alternate days for 35 weeks, and a gradual scaling down until therapy interruption. Criteria of efficacy were: skin score, serum ACE levels (s-ACE), chest X-ray (CXR), lung function tests (LFTs), and diffusing lung capacity for CO (DLCO). The skin score was computed as arithmetic sum of seven score parameters (min: 0, max: 28).
Skin score significantly decreased (P<0.001). Lower skin scores occurred after 3 and 6 months (P<0.05). s-ACE levels decreased over time at the third month (P<0.001). CXR assessed by radiological stage significantly improved during the first 6 months (P<0.001). DLCO showed a continuous trend of improvement. Minor side effects that have forced the suspension of the drug were drowsiness/sedation (74%), constipation (68%), and weight gain (53%). Deep vein thrombosis of the lower limbs occurred in one patient (who did not drop out the study). Eight patients (42%) abandoned thalidomide for axonal sensitive peripheral neuropathy (PN) between the ninth and the 24th month of treatment.
Thalidomide, long-term at mid-low doses, can be considered as an effective therapeutic alternative in chronic sarcoidosis with resistance or contraindications to steroids.
有限的数据报告表明沙利度胺可改善皮肤结节病；尚无关于其对肺部病变有益的报道。
评估对类固醇耐药或禁忌的肺结节病合并皮肤受累患者，采用沙利度胺长期治疗的可行性和疗效。
19 例患者接受沙利度胺治疗 24 个月，前 2 周给予 200mg/d，随后 11 周给予 100mg/d，35 周给予隔日 100mg 维持剂量，并逐渐减量直至停药。疗效标准为：皮肤评分、血清 ACE 水平（s-ACE）、胸部 X 线（CXR）、肺功能检查（LFTs）和一氧化碳弥散量（DLCO）。皮肤评分通过 7 项评分参数的算术和计算（最小值：0，最大值：28）。
皮肤评分显著降低（P<0.001）。第 3 个月和第 6 个月后皮肤评分较低（P<0.05）。s-ACE 水平在第 3 个月随时间下降（P<0.001）。通过放射学分期评估的 CXR 在最初 6 个月内显著改善（P<0.001）。DLCO 呈持续改善趋势。导致药物暂停的轻微副作用包括嗜睡/镇静（74%）、便秘（68%）和体重增加（53%）。1 例患者（未退出研究）下肢深静脉血栓形成。8 例（42%）患者在治疗第 9 至 24 个月因轴索性感觉周围神经病（PN）而放弃沙利度胺治疗。
长期应用中低剂量沙利度胺可作为类固醇耐药或禁忌的慢性结节病的有效治疗选择。
