Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction

Alfredo, Melissa de Almeida Corrêa; Schmitt, Juliano Vilaverde; Miola, Anna Carolina; Milagres, Simone de Pádua; Lastoria, Joel Carlos

doi:10.1016/j.abd.2023.01.006

Acessibilidade / Reportar erro

Brasil

Anais Brasileiros de Dermatologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • An. Bras. Dermatol. 99 (1) • Jan-Feb 2024 • https://doi.org/10.1016/j.abd.2023.01.006 copy

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction^☆ ☆ Study conducted at the Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Thalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients.

Objective:

To evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone.

Methods:

Analytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up.

Results:

A total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR = 6.46 [3.92 to 10.65]; p<0.01).

Study limitations:

Small number of events, single-center retrospective study.

Conclusion:

The hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

KEYWORDS
Leprosy; Thalidomide; Venous thrombosis

Sex	Age	Event	Smoker	SAH	DM	Time of follow-up	Time of TH use
Female	38	Iliofemoral DVT	No	Yes	No	9 m	2 m
Male	45	DVT in R lower limb	Yes	No	No	70 m	10 m
Male	49	Splenic infarction and aortic mural thrombosis	No	No	No	39 m	6 m
Male	54	AMI	Ye s	Ye s	Yes	56 m	11 m
Male	68	Iliofemoral DVT	Yes	Yes	No	74 m	12 m

Variable	With CVE and the use of TH^a a CVE, Cardiovascular Event; TH, Thalidomide; CT, Corticosteroids. No patient without thalidomide use had CVE during the follow-up. n = 5 (%)	Without CVE with the use of TH^a a CVE, Cardiovascular Event; TH, Thalidomide; CT, Corticosteroids. No patient without thalidomide use had CVE during the follow-up. n = 27 (%)	Without TH use^a a CVE, Cardiovascular Event; TH, Thalidomide; CT, Corticosteroids. No patient without thalidomide use had CVE during the follow-up. n = 57 (%)	Prevalence ratio 95% CI^e e Prevalence ratio between patients with and without CVE.	p
Females^b b Fisher’s exact test.	1 (20)	11 (40.7)	16 (28.1)	0.62 (0.10 a 3.69)	0.99
Time of follow-up (months)^c c Mann-Whitney test. Mean ± standard deviation.	56 (39–56)	48 (33–86)	34 (17–55)	-	0.67
Age at follow-up onset (years)^d d Student’s t test. Median (1st quartile-3rd quartile).	46.8±10	57 ± 13	54.8± 15.1	-	0.19
Diabetes mellitus^b b Fisher’s exact test.	1 (20)	5 (18.5)	11 (19.3)	1.05 (0.17 a 6.40)	0.99
Systemic arterial hypertension^b b Fisher’s exact test.	3 (60)	10 (37)	23 (40.4)	1.52 (0.71 a 3.28)	0.39
Smoking^b b Fisher’s exact test.	3 (60)	2 (7.4)	15 (26.3)	2.96 (1.29 a 6.81)	0.07
Used TH with CT in the follow-up^a a CVE, Cardiovascular Event; TH, Thalidomide; CT, Corticosteroids. No patient without thalidomide use had CVE during the follow-up. ,^b b Fisher’s exact test.	5 (100)	14 (51.9)	-	6.46 (3.92 a 10.65)	<0.01
Time of TH use (months)^a a CVE, Cardiovascular Event; TH, Thalidomide; CT, Corticosteroids. No patient without thalidomide use had CVE during the follow-up. ,^c c Mann-Whitney test. Mean ± standard deviation.	10 (6–10)	13 (3–36)	-	-	0.24
Daily dosage (mg)^c c Mann-Whitney test. Mean ± standard deviation.	100 (100–100)	100 (100–100)	-	-	0.81

Sociedade Brasileira de Dermatologia Av. Rio Branco, 39 18. and., 20090-003 Rio de Janeiro RJ, Tel./Fax: +55 21 2253-6747 - Rio de Janeiro - RJ - Brazil
E-mail: revista@sbd.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] ⁎ Corresponding author. E-mail: melissa.alfredo@gmail.com (M.A. Alfredo).

Brasil

Brasil

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction☆ ☆ Study conducted at the Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Abstract

Background:

Objective:

Methods:

Results:

Study limitations:

Conclusion:

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction^☆ ☆ Study conducted at the Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.