Thalidomide works against central nervous system TB-related complications

Use of low-dose thalidomide in the adjunctive setting is beneficial in the treatment of paediatric patients who developed enlarging tuberculosis (TB) abscesses with a tolerable safety profile, a study has found.

The analysis was based on a retrospective cohort of 38 children (median age, 33 months; 20 boys) consecutively treated with adjunctive thalidomide for CNS TB-related complications over a 10-year period. Eight of the children (21.1 percent) were HIV-infected.

Most children presented with focal motor deficit (n=16), while others had cranial nerve palsies and signs of cerebellar dysfunction. Large dural-based lesions were detected in three children, blindness secondary to optochiasmatic arachnoiditis occurred in four children, and paraplegia due to spinal cord TB mass lesions in two children. All of those with HIV infection were severely immunocompromised at the onset of the TB disease, with a median CD4 percentage of 19.6 percent.

Adjunctive thalidomide therapy was given at 3-5 mg/kg/day, with duration varying according to complication type. Children compromised by TB mass lesions received treatment for a median of 3.9 months, whereas those with optic neuritis were treated for a median of 2.0 months.

All children showed satisfactory clinical and radiological responses, except for a single HIV-uninfected child with stage 3 drug-susceptible tuberculous meningitis who died. The reason for death was brainstem ischemia due to progressive TB-related vasculitis.

None of the children developed rashes, hepatitis, hematologic derangements, or complained of leg cramps.

The findings require further investigation into the potential role of thalidomide or analogues in the treatment of other TB-related complications.