(LML) Thalidomide and Brazil

Leprosy Mailing List – August 5,  2013 

Ref.:    (LML) Thalidomide and Brazil

From:  Dr. Diana Lockwood, LSHTM, London

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Dear LML readers,

 

 

I attach two papers relevant to the discussion on the possible role of thalidomide in limb reduction defects (LRD) in Brazil:

	Vianna Clin Dysmorph 2013.pdf
	journal.pone.0021735.pdf

 

 

1. Vianna FSL.  2011 PlosONE 2011 67e21735 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0021735

 

This papers reports on two babies born with limb reduction syndrome in Brazil in 2007. They were from a cohort of 16 neonate s with birth defects. 14 were excluded because there was either insufficient information or the syndrome was incompatible with LRD. Although the exclusion process was not specifically described, both the babies had limb reduction defects but neither mother confirmed taking thalidomide. Therefore it seems unlikely that thalidomide has caused the LRD in these babies.

 

2. Vianna 2013 Recognition of the phenotype of thalidomide embryopathy in countries endemic for leprosy: new cases and review of the main dysmorphological findings. . Clinical Dysmorphology 2013,22.59‑63

Here two cases are reported:

-       Case 1 has no date of birth given, nor dates of the mother's leprosy treatment. She was prescribed thalidomide and may have had a few leftover tablets at home. The dates and dose that she took are not given.

-       Case 2 was born in 1998 i.e. now aged 15. The mother had leprosy in the 90s and was treated and may have had ENL. It is not definitely stated that she received treatment with thalidomide. There is no mention of cross verification of any of her leprosy history with clinical records.  Therefore this case also only has a tenuous association with thalidomide.

It is critical to have the dates for the birth of these babies and to know how this relates to the supervision of thalidomide treatment. Both these cases need further verification and detailed work to exclude other causes of Thalidomide LRD. This data is not given. The authors state that other causes of limb reduction should be ruled out but do not state how this should be done

 

The data from Vianna 2011 is important because it shows that LRD can occur in Brazil without the mothers having exposure to thalidomide. It is important that other causes are excluded. The focus on thalidomide might result in another cause of limb reduction defect not being recognised.

 

 

 

Best Wishes,

 

Diana Lockwood

LSHTM, London

 

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