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The New England Journal of MedicineThalidomide for Recurrent Bleeding Due to Small-Intestinal Angiodysplasia

Thalidomide Shows Promise in Reducing Recurrent Bleeding Due to Small-Intestinal Angiodysplasia

A recent study has demonstrated the potential of thalidomide as a treatment for recurrent bleeding due to small-intestinal angiodysplasia (SIA), a condition that accounts for 5 to 10% of gastrointestinal bleeding cases.

Study Design

  • The study was a multicenter, double-blind, randomized, placebo-controlled trial.
  • Participants were patients with recurrent bleeding (at least four episodes in the previous year) due to SIA.
  • Patients were randomly assigned to receive thalidomide at an oral daily dose of 100 mg or 50 mg or placebo for 4 months.
  • Patients were followed for at least 1 year after the end of the 4-month treatment period.

Key Findings

  • 150 patients underwent randomization: 51 to the 100-mg thalidomide group, 49 to the 50-mg thalidomide group, and 50 to the placebo group.
  • The percentages of patients with an effective response were 68.6% in the 100-mg thalidomide group, 51.0% in the 50-mg thalidomide group, and 16.0% in the placebo group.
  • Adverse events were more common in the thalidomide groups than in the placebo group overall; specific events included constipation, somnolence, limb numbness, peripheral edema, dizziness, and elevated liver-enzyme levels.

HCN Medical Memo
With angiodysplasia, the vessels found directly adjacent to the lumen, or opening, of the GI tract can become fragile and can burst leading to blood loss. It is the most common vascular malformation in the GI tract and most frequently occurs in the colon. It can also affect the large intestine, small intestine, or stomach. (Source: Osmosis from Elsevier)

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