Thalidomide and Lenalidomide for Refractory Systemic/Cutaneous Lupus Erythematosus Treatment

A Narrative Review of Literature for Clinical Practice

Emily Figueiredo Neves Yuki, MD; Clovis A. Silva, MD, PhD; Nadia E. Aikawa, MD, PhD; Ricardo Romiti, MD, PhD; Carlos Otto Heise, MD, PhD; Eloisa Bonfa, MD, PhD; Sandra Gofinet Pasoto, MD, PhD


J Clin Rheumatol. 2021;27(6):248-259. 

In This Article


Thalidomide may be used as an "induction therapy" for patients with severe/refractory cutaneous lupus with high risk of scarring, and its use for extended periods should be avoided. This drug is associated with a very high rate of response within a short period, but relapse is frequent after drug is withdrawn. Polyneuropathy is a concern, and nerve conduction studies are suggested every 6 months for early diagnosis. Clinical reversibility of this adverse effect occurs for most patients. The overall risk of thrombosis may be minimized with HCQ association, whereas for those with aPL positivity aspirin is recommended. Lenalidomide is a promising drug for cutaneous lupus with a very high rate of complete/partial response and no cases of neuropathy or worsening of previous thalidomide-induced neuropathy; however, more studies are needed.