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

Marlowe, S.N.S., Leekassa, R., Bizuneh, E., Knuutilla, J., Ale, P., Bhattarai, B., Sigdel, H., Anderson, A., Nicholls, P.G., Johnston, A., Holt, D. and Lockwood, D.N.J. (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. 1004-1012. (doi:10.1016/j.trstmh.2006.11.010).


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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; 5–7.5 mg/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 5 mg/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 7.5 mg/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 5 mg/kg/day seems efficacious in Nepalis, but a higher dose may be required in Ethiopian patients.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.trstmh.2006.11.010
ISSNs: 0035-9203 (print)
Keywords: leprosy, ciclosporin, reversal reaction, treatment outcome, Ethiopia, Nepal

ePrint ID: 59017
Date :
Date Event
October 2007Published
Date Deposited: 21 Aug 2008
Last Modified: 16 Apr 2017 17:35
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