Thalidomide Curbs Refractory Itching in Some HIV Patients

Treatment with thalidomide may help reduce the signs and symptoms of severe itching (prurigo nodularis) in HIV-infected patients, according to the findings of a small trial.

"From our experience, thalidomide appears to be an efficacious drug for prurigo nodularis in HIV," lead investigator Dr. Toby Maurer told Reuters Health. "This is a very difficult disease to control and the itching is all-consuming for patients."

Standard treatment of the condition includes use of antihistamines, ultraviolet light and corticosteroids, Dr. Maurer and colleagues at the University of California, San Francisco report in the July issue of the Archives of Dermatology.

However, they observe that treatment of prurigo in HIV-infected patients "is particularly challenging given the recalcitrant nature of the skin disease and the possible risk of immunosuppressive therapy."

To evaluate the use of thalidomide, the researchers studied 10 HIV-infected patients with prurigo nodularis refractory to standard therapy for at least 1 year.

All of the subjects received 100 mg thalidomide daily for 1 month, and were then randomized to 100 mg or 200 mg daily. If side effects were seen, the dosage was reduced or the drug was discontinued. Altogether, dosages ranged from 33 mg to 200 mg daily.

Over an average of 3.4 months, 8 subjects, who were treated for longer than 1 month, had a more than 50% reduction in itch. Three of the patients developed thalidomide peripheral neuropathy. However, there was no correlation between treatment duration, daily or cumulative dosage and appearance of neuropathy.

With careful monitoring of side effects, the researchers conclude, "thalidomide shows promise as an effective medication in HIV-infected patients with prurigo nodularis."

Nevertheless, Dr. Maurer stressed that "thalidomide is a teratogen and again, guidelines must be closely followed before administering this drug."

07/30/04

Arch Dermatol 2004;140:845-849.