Leprosy Mailing List, December 24th, 2008
Ref.: Steroid therapy in leprosy should be individualised.
From: Chukwu J., Enugu, Nigeria
Dear Noto,
I would like to congratulate you and all LML readers/contributors on the current vigorous debate on duration of steroid regimens for leprosy reactions. Our hope and indeed expectation is that this healthy exchange should not end in winners and losers but rather in a broad consensus and joint action to establish an evidence-based regimen.
It is reassuring to learn that a protocol is already in place for a multi-centre trial (Wim van Brakel LML Dec. 2, 2008). In view of the great diversity in relation to man and microbe as acknowledged by Dr. Ben Naafs (….’leprosy in one geographical area is not that in another’) as well as the need to complete enrolment quickly, I suggest that the trial co-ordinators consider including more countries.
As we embark on the study, it is important that some consensus is achieved on what to do with the current guidelines: should we recommend that cases of severe reaction be managed with individually-tailored steroid regimens in referral centres until study results are available?
Best wishes from Nigeria,
Joseph Chukwu
GLRA Nigeria
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