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Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Stéphane NAHON
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2016/07  
 
  2016 Jul;14(7):966-972.e2  
  doi : 10.1016/j.cgh.2015.10.034  
 
  Long-term Outcomes of Thalidomide Therapy for Adults With Refractory Crohn's Diseas  
 
  Simon M, Pariente B, Lambert J, Cosnes J, Bouhnik Y, Marteau P, Allez M, Colombel JF, Gornet JM  
  https://www.ncbi.nlm.nih.gov/pubmed/26598226  
 
 

BACKGROUND & AIMS:

Little is known about the efficacy and safety of thalidomide therapy for patients with refractory Crohn's disease (CD), particularly in respect to long-term outcomes of patients.

METHODS:

We conducted a retrospective multicenter observational study to evaluate thalidomide efficacy and the probability of its withdrawal because of either toxicity or lack/loss of efficacy. We analyzed data from 77 patients with active intestinal and/or perineal CD, refractory to conventional immunosuppressive therapies, treated with thalidomide at 5 tertiary referral inflammatory bowel disease centers in France. We also analyzed the long-term efficacy of thalidomide.

RESULTS:

Fifty-four percent of the patients were in clinical remission after thalidomide treatment within the first year. The proportions of patients from whom thalidomide was withdrawn because of lack/loss of efficacy and/or toxicity were 35% at 3 months of treatment, 69% at 12 months, and 88% at 24 months. The proportions of patients from whom thalidomide was withdrawn because of toxicity alone were 22% at 3 months, 34% at 12 months, and 46% at 24 months. Overall, neuropathy occurred in 30 patients and was the main reason for thalidomide withdrawal.

CONCLUSIONS:

On the basis of a retrospective multicenter observational study, thalidomide therapy is effective in most patients with refractory active intestinal and/or perineal CD. However, its toxicity limits its use as a maintenance therapy.

 
Question posée
 
Quelle est l’efficacité et la tolérance du thalidomide au long cours au cours de la maladie de Crohn ?
 
Question posée
 
Dans cette cohorte française rétrospective, le thalidomide permet une rémission clinique après un an de traitement dans 54% des cas. Cependant, les taux d’arrêt du traitement en raison d’une intolérance étaient élevés, respectivement 22% à 3 mois, 34% à 12 mois, et 46% à 24 mois.
 
Commentaires

Le thalidomide peut représenter une alternative intéressante en cas d’échec aux traitements classiques chez les patients atteints de maladie de Crohn. Cependant, son utilisation doit être réservée à des centres experts habitués à la gestion fréquente des effets secondaires.

 
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