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Efficacy has been confirmed in several studies, although recurrence after discontinuation of treatment is frequent. More recent experience suggests that lower doses than originally used may be effective, which may result in a reduction in side effects. Much effort has been expended in studying the mechanisms of action of thalidomide, although as yet it is unclear which of the mechanisms identified to date contribute to its efficacy in treating cutaneous forms of lupus erythematosus. Identification of patients suitable for thalidomide therapy requires a rigorous selection process. Potential side effects should be clearly explained, particularly teratogenicity as many patients are young women. Written consent and a negative pregnancy test must be obtained prior to commencement of therapy. Reliable contraceptive measures should be strictly observed by patients taking thalidomide. Close clinical and neurophysiological supervision using nerve conduction studies should be undertaken. <\/jats:p>","DOI":"10.1191\/096120301677213822","type":"journal-article","created":{"date-parts":[[2003,11,12]],"date-time":"2003-11-12T12:45:16Z","timestamp":1068641116000},"page":"188-192","source":"Crossref","is-referenced-by-count":28,"title":["Update on therapy \u2014 thalidomide in the treatment of lupus"],"prefix":"10.1177","volume":"10","author":[{"given":"M Y","family":"Karim","sequence":"first","affiliation":[{"name":"Lupus Research Unit, Rayne Institute, St Thomas' Hospital,                         London, UK; Department of Immunology, 2nd Floor, North Wing, St                         Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Ruiz-Irastorza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M 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