Thalidomide for management of refractory oral mucosal diseases

Background Thalidomide has anti-inflammatory properties and has been used off-label for multiple mucocutaneous disorders, but its application in managing refractory oral mucosal diseases is unclear. This study aimed to review the efficacy and safety of thalidomide in treating various oral mucosal disorders refractory to conventional therapies. Methods The medical records of patients who were prescribed thalidomide from 2002 through 2021 for oral mucosal disorders were reviewed. Data collected included demographics, oral mucosal disease diagnosis, treatment courses, and thalidomide dose, duration, response, and side effects. Results Thalidomide was prescribed for 28 patients with diagnoses of recurrent aphthous stomatitis (n=14), inflammatory oral lichenoid lesions (n=6), traumatic ulcerative granuloma with stroma eosinophilia (n=5), chronic radiation-induced mucositis (n=2), and orofacial granulomatosis (n=1). Patients were treated for a median duration of 84 days (range 2 to 1582). Clinical improvement was observed in 19 of 22 patients who completed at least 1 cycle of thalidomide (86.4%), with complete resolution in 12 patients (54.5%). Adverse events occurred in 75% of patients (n=21), with 8 requiring thalidomide discontinuation. The most common adverse events included peripheral neuropathy (42.9%), drowsiness (28.6%), and constipation (21.4%). Conclusions Thalidomide may be considered for the management of refractory oral mucosal disorders. Drug side effects are common and need monitoring closely during use.