In discussions regarding the treatment of certain cancers and some immune system disorders, two medicines are often mentioned: lenalidomide and thalidomide. Both of them are categorized as immune system modifying medications. Such medications have altered the treatment of disorders such as multiple myeloma, myelodysplastic syndromes and some forms of lymphomas. Even though thalidomide and lenalidomide dip from the same source, their mechanisms of action, side effects, and clinical applications differ in a number of ways. Knowing the differences is important to patients, caregivers and professionals in the health field.
What is Thalidomide?
The introduction of Thalidomide to the market took place in the year nineteen fifty. It was said to be a safe treatment in the form of a sleeping pill as well as a form of medicine for morning sickness in pregnant women. Its association with terrible deformities in thousands of children led to the very justified Thalidomide controversy and as a result its distribution is very limited.
In hindsight, researchers have discovered that Thalidomide is effective in reducing the intensity of certain inflammatory conditions, and could, to some extent, angiogenesis- the formation of new blood vessels. This merited the utility of Thalidomide in conditions with excessive vascularization accompanied by certain immune responses, as well as complications arising from leprosy.
What is Lenalidomide?
Lenalidomide is a recent development in medicine, which is an improvement to thalidomide by making it much safer. The goal was to radical thalidomide's harm if possible, but hold on to its positive effects. Currently, lenalidomide is a common medicine to treat multiple myeloma, mantle cell lymphoma and some blood disorders which include myelodysplastic syndromes with deletion 5q.
Lenalidomide is available in different strengths such as Lenalidomide 5mg, Lenalidomide 10mg, Lenalidomide 20mg and Lenalidomide 25mg. This strengths allows physicians to tailor the dosage considering the patients condition and their therapeutic approach.
How Do They Work?
Regardless of being in the same category of drugs, thalidomide and lenalidomide do different things. Like all cancer therapy drugs, they focus on the immune system and somehow disrupt the mechanism by which cancer cells proliferate.
Thalidomide reduces the expression of some proteins that are responsible for inflammation as well as the growth of the tumor. Also, it thwarts blood vessel formation that are essential for tumor survival.
Lenalidomide is more of an improvement to thalidomide and works in similar ways. It is known to more actively stimulate the immune system's response, resulting in a more pronounced attack on cancerous cells. Also, it enhances the immune cells‘ ability to target and destroy abnormal cells, while preserving normal healthy cells. This is why lenalidomide is widely used to treat many types of cancer.
Effectiveness in Treatment
Research illustrates that in the treatment of thalidomide in treatment of lenalidomide, it is most of the time the case that thalidomide is less effective in thalimoidomic conditions. Recurrent multiple myeloma, for instance, in combination with any medication, the standard treatment for the condition, the patient is able to live longer.
There are situations, in which, thalomid is still utilized to this day as in cases with thalidomide, which was termed for more sparsely used regions with lenalidomide. It is worth noting that physicians prefer lenalidomide more because of the high side effect profile that thalidomide typically presents.
Side Effects
The most marked shift between the two medications in this instance for the sake of the discussion is the side effect profile.
Thalidomide was described as the more dangerous variante to be exposed to, as it triggers bouts of sever drowsiness with constipation, defects pertaining to the peripheral nervous system, as well as the risk of dangerously uncontrollable childbirth. Peripheral nerve damage is known to be one of the most dangerous side effects.
On the other hand, lenalidomide seems to be better tolerated, however, it can still come with side effects, which include low blood levels, pallor, digestive disorders, blood lethargy and, along with thalidomide, is unsafe for pregnant women. All of these do require constant monitoring and management to prevent any health complications that may arise.
Safety and Monitoring
As part of the systematic difference of side effects between the two medications, it was concluded that along with other critical side effects, the risk of exposure to pregnancy with these two medications was equally as critical, primarily pertaining to the risk of exposure to limb and organ malformation.
In these cases, along with other drugs and with thorough expense, it was emphasized that both woman and men, along extreme exposure, are to be exposed to these medications, which equally does include abiding by the rules of conducting them with contraceptive methods.
Patients on lenalidomide or thalidomide have to get routine blood work to assess blood cell levels and assess the functioning of various organs. Based on the results they get, the physicians change the dosage to maintain the safeness and effectiveness of the treatment.
Availability and Use
With the exception of a few cases, thalidomide is not frequently prescribed anymore. In some places thalidomide is used under very strict conditions, such as for the treatment of complications arising from leprosy.
In contrast, lenalidomide is prescribed much more often and is available in various different dosage forms. Depending on the stage of treatment and other individual patient factors, a physician may prescribe lenalidomide in the dosage of either 5mg, 10mg, 20mg, or 25mg. This ease of dosing makes lenalidomide a more versatile and available drug in today’s oncology practice.
Lenalidomide Cost
Patients are often curious to know the lenalidomide cost. It is important to point out that the cost of lenalidomide is highly variable depending on the geographical area, brand, and strength of the dosage form. In general, lenalidomide cost more than thalidomide. However, due to the highly effective and safe profile of lenalidomide, many physicians first prescribe lenalidomide. The cost of lenalidomide may decrease over time as more generic forms are being introduced.
Key Differences at a Glance
The most essential distinctions to keep in mind even though both medications originate from the same family are the following:
· Lenalidomide is stronger and often more effective than thalidomide.
· Both thalidomide and lenalidomide have been noted to have side effects. However thalidomide impacts nerves more negatively whilst lenalidomide primarily impacts blood counts negatively.
· Unlike thalidomide which is kept for more complex cases, lenalidomide can be prescribed more easily in cancer.
· For lenalidomide thalidomide dosing is less flexible due to strength availability.
· Despite the adverse effects, long-term results for lenalidomide, although used less frequently, are promising.
Making the Right Choice
The decision for lenalidomide or thalidomide should not be entirely for the patient to decide. The doctor has to take a number of things into account when prescribing, like the disease type, patient's age, other medical issues if there are any, and the side effects the patient may experience.
For these patients diagnosed with multiple myeloma or relevant conditions, lenalidomide has become the norm because it optimizes their quality of life and life span. In these patients, thalidomide is less frequently used due to safety issues, although it can be prescribed in some cases.
Conclusion
Both lenalidomide and thalidomide remain critical in the treatment of cancer and cancer-related disorders of the immune system. While thalidomide began the fight over 60 years ago, lenalidomide has become the treatment of choice for its greater efficacy and safety. As in the case of any medication, patients need to adhere to their doctor’s recommendations, educate themselves on any likely adverse effects, and keep up with baseline and continuous follow-up evaluations. With continuous research and the various strengths available such as Lenalidomide 5mg, Lenalidomide 10mg, Lenalidomide 20mg, and Lenalidomide 25mg, treatment continues to improve for patients across the globe.
FAQs
What distinguishes lenalidomide from thalidomide?
What distinguishes lenalidomide from thalidomide the most is that lenalidomide is stronger, effective, and safer, while thalidomide possesses more severe nerve-associated side effects.
Is lenalidomide able to substitute thalidomide in every instance?
Not always. Lenalidomide is the ideal choice, but there are many instances and places where thalidomide is the only option available, especially in the case of cost and supply.
What makes lenalidomide more expensive than thalidomide?
Lenalidomide is more expensive than thalidomide because the former is a more recent medicine and has higher research and development costs. It also has more favorable outcomes in treatment which increases its worth in most clinical settings.
Lenalidomide and Pregnancy: What the Literature Says
It is a well documented fact that lenalidomide use during pregnancy is a category X drug which means it is contraindicated; it is known to cause severe teratogenic effects. Women who are pregnant as well as those who are intending to get pregnant must refrain from use.
How Is Lenalidomide dosage Calculated
The parameters that are used are the most current blood tests as well as the individual patient’s overall ‘wellness’. Fortunately we can easily adjust lenalidomide therapy with the use of Lenalidomide 5mg, Lenalidomide 10mg, Lenalidomide 20mg, and Lenalidomide 25mg.
