The birth defects caused by thalidomide led to the development of greater drug regulation and monitoring in many countries.It was approved in the United States in 1998 for use as a treatment for cancer. It is on the World Health Organizations List of Essential Medicines. It is available as a generic medication. Medical uses
Thalidomide is used as a first-line treatment in multiple myeloma in combination with dexamethasone or with melphalan and prednisone to treat acute episodes of erythema nodosum leprosum and for maintenance therapy.The bacterium that causes tuberculosis (TB) is related to leprosy. Thalidomide may be helpful in some cases where standard TB drugs and corticosteroids are not sufficient to resolve severe inflammation in the brain.It is used as a second-line treatment to manage graft versus host disease and aphthous stomatitis in children and has been prescribed for other conditions in children, including actinic prurigo and epidermolysis bullosa; the evidence for these uses is weak. It is recommended only as a third line treatment in graft-versus-host-disease in adults because of lack of efficacy and side effects observed in clinical trials. Contraindications
Thalidomide should not be used by men or women who are trying to father or conceive a child, or who cannot or will not follow the risk management program to prevent pregnancies, or by women who are breastfeeding or pregnant. The prescribing doctor is required to ensure that contraception is being used, and regular pregnancy tests are taken. Those allergic to thalidomide should not take it.
Revlimid is available only in a restricted distribution setting to avoid its use during pregnancy. Further studies are being conducted to find safer compounds with useful qualities. Another more potent analog, pomalidomide, is now FDA approved. Additionally, apremilast was approved by the FDA in March 2014. These thalidomide analogs can be used to treat different diseases, or used in a regimen to fight two conditions.Interest turned to pomalidomide, a derivative of thalidomide marketed by Celgene. It is a very active anti-angiogenic agent   and also acts as an immunomodulator. Pomalidomide was approved in February 2013 by the U.S. Food and Drug Administration (FDA) as a treatment for relapsed and refractory multiple myeloma. It received a similar approval from the European Commission in August 2013, and is expected to be marketed in Europe under the brand name Imnovid. Clinical research
There is no conclusive evidence that thalidomide or lenalidomide is useful to bring about or maintain remission in Crohns disease.Thalidomide was studied in a Phase II trial for Kaposis sarcoma, a rare soft-tissue cancer most commonly seen in the immunocompromised, that is caused by the Kaposis sarcoma-associated herpesvirus (KSHV). References
Further reading
External links
"Thalidomide". Drug Information Portal. U.S. National Library of Medicine. Daemmrich A (7 December 2015). "Remind me again, what is thalidomide and how did it cause so much harm". The Conversation.