Pharmacology of thalidomide

Thalidomide is best known for its sedative, antiemetic, and teratogenic effects but also has diverse pharmacologic properties and therapeutic potential in infectious, autoimmune, and various inflammatory conditions. Thalidomide was recently approved in the United States as acute and maintenance therapy for erythema nodosum leprosum (ENL) and appears to be particularly promising in the management of human immunodeficiency virus (HIV)-related complications, including aphthous ulcers and wasting syndromes. The discovery that thalidomide inhibits angiogenesis led to preclinical and phase I/II trials of thalidomide as an anticancer agent in solid tumors and hematologic malignancies. Many outstanding issues surround the pharmacology of thalidomide, including its absorption, distribution, and mechanism(s) of therapeutic activity in an array of disease states. The adverse event profile associated with thalidomide in the ENL population is well established but may be modified as safety data and clinical experience accumulate from other patient populations. Research continues to establish the pharmacokinetic and pharmacodynamic properties of thalidomide and to define its role in the oncology/hematology arena. Copyright (C) 2000 by W.B. Saunders Company.