Safety and efficacy of thalidomide in treatment of gastrointestinal bleeding secondary to angioectasias: a systematic review and meta-analysis

Abstract

Background

Thalidomide has been used for angioectasia-associated refractory gastrointestinal bleeding (GIB), with studies showing variable efficacy and side effects profile. We conducted a meta-analysis to reconcile the data.

Methods

Online databases were searched for studies evaluating thalidomide in patients with refractory/recurrent GIB due to angioectasias. The outcomes of interest were cessation of bleeding, rebleeding, need for blood transfusion, hospitalization and adverse events. Pooled proportions for incidence, and odds ratios (OR) for comparison with control were calculated along with 95% confidence interval (CI).

Results

A total of seven studies with 346 patients (n = 269 thalidomide, n = 77 control) were included. Thalidomide dose was usually started at 50–100mg/day. The mean age was 65 years, 45% patients were men, and mean follow-up was 1.8 years. The pooled clinical outcomes with thalidomide were: cessation of bleeding 42.2% (95% CI 36.02 to 48.41), rebleeding 30%, need for blood transfusion 20.1%, hospitalization 40% and adverse events 55.9%. When compared with the control group in 2 studies, patients on thalidomide had significantly higher odds of cessation of bleeding (OR 21.40, 95% CI 5.78 to 79.29, p < 0.00001) and adverse events, with lower need for blood transfusion and hospitalization.

Discussion

In patients with angioectasias-related refractory/recurrent GIB, the use of thalidomide results in significantly decreased bleeding risk and may play a role in the management of such patients.

Keywords:

• Thalidomide
• gastrointestinal bleeding
• angioectasia
• angiodysplasia

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sahib Singh and Babu P. Mohan. The first draft of the manuscript was written by Sahib Singh and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethical statement

This is a meta-analysis of already published studies and the study-level data are available for the public view. Therefore, the study did not require ethics approval.

Guarantor of the article

Sahib Singh accepts full responsibility for the conduct of the study, has access to the data and has control of the decision to publish.

Disclosure statement

DGA: consultant for Boston Scientific.

NS: consultant: Boston Scientific, Olympus, Medtronic, Mauna Kea. Advisory board Endoscopy now.

All other authors declare that there is no conflict of interest.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.