Leprosy Mailing List – May 13th, 2011
Ref: Management of Type I reaction (reversal reaction)
From: P. Saunderson, Greenville, SC, USA
Dear Salvatore,
In relation to the management of Type 1 reactions, I would like to make a few comments:
1. There is general agreement that steroid treatment probably needs to be longer than 12 weeks, although 30-40 mg seems to be an adequate starting dose. There is a need for better evidence from well-designed clinical trials, before we can state clearly what is the best routine treatment for Type 1 reactions.
2. A good starting point for discussion at the moment is the paper by Rao PS, Sugamaran DS, Richard J, Smith WC: Multi-centre, double blind, randomized trial of three steroid regimens in the treatment of type-1 reactions in leprosy. Lepr Rev. 2006 Mar;77(1):25-33. The paper is attached.
3. On the basis of this paper, The Leprosy Mission now advocates the 20 week regimen tested in the trial, namely: prednisolone 30mg for 2 weeks, 25mg for 2 weeks, 20mg for 8 weeks, 10 mg for 4 weeks, 5mg for 4 weeks. The aim is to extend the length of the course, but keep the total dose of prednisolone as low as possible.
4. A new randomized, controlled trial is just about to start under the name ‘TENLEP’ (Treatment of Early Neuritis in Leprosy), which is a multi-center study managed by the Royal Tropical Institute (KIT) in Amsterdam. This study will compare a 20 week regimen with a 32 week regimen in the treatment of new nerve function impairment, which is closely related to the occurrence of a Type 1 reaction.
Paul Saunderson MD, MRCP
Medical Director
American Leprosy Missions
1 ALM Way, Greenville, SC 29601, USA
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