Leprosy Mailing List – August 2, 2013
Ref.: (LML) Thalidomide and Brazil
From: Fernanda Vianna, Porte Alegre, Rio Grande de Sul, Brazil
Dear Diana Lockwood and other readers
Firstly, thank you for bringing this important and relevant topic to the attention of the LML readers and asking questions about these published numbers.
You are entirely correct about the reporter's interpretation. However we would like to clarify the following points:
1. We conducted a surveillance of limb reduction defects compatible to thalidomide syndrome in Brazil during six years (2005-2010) and identified around 100 babies born with this phenotype (description of the phenotype is in Vianna et al., 2011), based on the Brazilian Livebirth Declaration.
2. We do not investigate each case to know the cause of these anomalies. It is an ecological study and certainly includes other syndromes with similar phenotype, as Holt-Oram among others. However, we observed an association between the number of thalidomide tablets dispensed and thalidomide-like defects. Moreover, unexpected clusters of these malformations in different geographical regions of Brazil were identified.
3. Two thirds of thalidomide dispensed in Brazil is for treating ENL, the rest for the treatment of other diseases (multiple myeloma, lupus, ...). Most of the confirmed cases identified by our group had prescription for ENL (Schuler-Faccini et al., 2007; Vianna et al., 2013)
4. There is legislation that regulates the use of thalidomide in Brazil, forcing women of childbearing age to use two contraceptive methods plus regular pregnancy tests. Besides, alerts about sharing drug are given. This information and others are made available including on the box of thalidomide that patients bring to their homes. This legislation has been subjected to improvements the past two years and we expect a significant reduction in the thalidomide affected babies coming years.
Please see the attached files to this letter.
Regards,
Fernanda Vianna,
INAGEMP, Medical Genetics Service,
Hospital de Clinicas Porte Alegre,
Rio Grande deSul, Brazil
LML - S Deepak, B Naafs, S Noto and P Schreuder
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