Axial spondyloarthropathy (SpA) is seronegative arthritis which mainly affects young adults and causes much morbidity. Tumor necrosis factor-alpha (TNF-α) is one of the main mediators of inflammation in joints and enthuses in SpA. Nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologics like TNF-α inhibitors are the mainstay of therapy in SpA. However, in India, the cost is one limiting factor in the use of biologics for the treatment of SpA in eligible patients. Thalidomide is an oral TNF-α inhibitor which has reported benefit in axial SpA, and it is a cheap option in the Indian setting. However, there is almost no Indian data on its efficacy.
Materials and methods
This is a retrospective analysis of patients receiving thalidomide for axial SpA in the rheumatology clinic of a tertiary care hospital of Kolkata. In this clinic, thalidomide was used at 100 mg/day. Patients receiving thalidomide, who had completed at least one year follow up were included in the analysis. Assessment of SpondyloArthritis International Society (ASAS)-20, ASAS-40, and ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) were measured three monthly during the follow-up. Side effect profile of thalidomide was also recorded.
The completed data of 66 patients were analyzed. All patients were human leukocyte antigen (HLA) B27 positive. Ninety-five point percent fulfilled ASAS-20 criteria at 12 months and 71.2% fulfilled the ASAS-40 criteria at 12 months. Three patients were nonresponders. The average ASDAS-CRP score also decreased from 2.9 to 1.5 over one year.
In our study, oral thalidomide resulted in significant improvements in axial SpA. Further randomized controlled trials are needed to find the relative efficacy of thalidomide with respect to other forms of treatment.