Thalidomide, which was developed as a nonbarbiturate sedative agent, was taken 
off the market in 1961 after it was linked to a spate of major birth defects. 
Gradually, thalidomide was reintroduced for the treatment of a few skin diseases 
including leprous erythema nodosum, severe mucosal ulcers (e.g., associated with 
HIV infection or Behçet's disease), lymphocytic skin infiltrations, cutaneous 
lupus erythematosus, and chronic graft-versus-host disease. Recent reports of 
original pharmacological properties including modulation of cytokine production 
(mainly reduced TNF-alpha production) and inhibition of angiogenesis have led to 
the suggestion that thalidomide may be useful in some inflammatory and 
neoplastic conditions. Several open-label studies and case reports have 
described the effects of thalidomide in Crohn's disease, rheumatoid arthritis, 
ankylosing spondylarthritis, systemic sclerosis, and a few other systemic 
disorders. In these indications, minor but dose-limiting side effects were 
apparently common. Thalidomide analogs with better acceptability profiles are 
under evaluation. The anti-angiogenic effects of thalidomide may make this 
compound valuable as single-drug therapy or as an adjunct to chemotherapy in 
patients with cancer, particularly those with metastases or multiple myeloma. 
This possibility requires further evaluation.