Response to ciclosporin treatment in Ethiopian and Nepali patients with severe leprosy Type 1 reactions.


Marlowe, SN; Leekassa, R; Bizuneh, E; Knuutilla, J; Ale, P; Bhattarai, B; Sigdel, H; Anderson, A; Nicholls, PG; Johnston, A; Holt, D; Lockwood, DN; (2007) Response to ciclosporin treatment in Ethiopian and Nepali patients with severe leprosy Type 1 reactions. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101 (10). pp. 1004-12. ISSN 0035-9203 DOI: https://doi.org/10.1016/j.trstmh.2006.11.010

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Abstract

Leprosy type 1 reactions (T1R) are immune-mediated events with inflammation of peripheral nerves and skin. We report the clinical outcomes of a closely monitored open prospective trial in which eight Nepali and 33 Ethiopian patients with T1Rs were treated with an Indian generic formulation of ciclosporin (Cn; 5-7.5mg/kg/day) for 12 weeks and followed up for 24 weeks after starting treatment. Outcomes were measured using a clinical severity score. Among the Nepalis, 75-100% improved in all acute clinical parameters; 67-100% patients maintained improvement, except for those with acute sensory nerve impairment among whom 67% relapsed after stopping treatment. The skin lesions of all Ethiopians on 5mg/kg/day of Cn improved and 50-60% had peripheral nerve function improvement. Most Ethiopians needed a higher dose of Cn to improve nerve impairment and neuritis, and 50-78% of them developed worse clinical severity scores when Cn was stopped. Four Ethiopians and two Nepalis developed elevated serum creatinine levels on 7.5mg/kg/day Cn, and three (9%) Ethiopians developed treatable hypertension. This suggests that Cn monotherapy is an effective treatment for severe T1R with few adverse effects. A dose of 5mg/kg/day seems efficacious in Nepalis, but a higher dose may be required in Ethiopian patients.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 17669450
Web of Science ID: 250027800010
URI: http://researchonline.lshtm.ac.uk/id/eprint/9351

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