Treatment of reactions sometimes needs to be extended more than 6 months

Leprosy Mailing List – May 18^th, 2011 

Ref:    Treatment of reactions sometimes needs to be extended more than 6 months.

From: B Naafs, Munnekeburen, The Netherlands

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Dear Salvatore,

Concerning the remarks of Paul Saunderson in LML May 13^th 2011.  Research to understand reactions and nerve damage is essential, but should serve a purpose.  The purpose is in my opinion "to gain understanding in order to improve treatment".  Treatment has been well described in the past and many patients have benefited.  Among the earlier papers, based on the extensive experience of John Pearson there is:-

         

            B. Naafs, J.M.H. Pearson and H.W. Wheate

            Reversal Reaction: The prevention of permanent nerve damage. Compari­son of short and long term steroid treat­ment.

            Int. J. Lepr. 47 (1979) 7-12

Many however followed the notion, expressed in so called “evidence based medicine”, that observational studies do not provide strong evidence.  Leprosy experts pushed therefor to shorten treatment protocols.  The result was that in the management of Type 1 leprosy reactions patients were, for a long time, not getting adequate treatment.

Leprosy experts with no “hands on” experience have designed and inspired trials which were not adequately designed, not taking in account what was earlier written and which only could conclude that the treatment should be longer and further research has to be done.  For the benefit of whom?  Researchers from Bauru, Addis Ababa, Karigiri, Hyderabad and Chandrigar had already shown long before, that reaction treatment sometimes needs to be extended to more than 6 months.  May be those recent trials teach some of the clinicians who conducted the trial.  But it takes longer to reach the less experienced leprologists and programme managers who have not enough experience to follow their own observations and those of the older literature.

In desperation I wrote two papers which should be kept in mind judging future trials and advises of authorities.

B. Naafs

Treatment duration of reversal reaction: A reappraisal. Back to the past.

Lepr. Rev. 74 (2003) 328-336

B. Naafs

Treatment of leprosy: science or politics?

            TM&IH 11 (2006) 268- 278

I’m afraid that even the mentioned Tenlep trial does not take the duration of reactions in some, especially MB, patients in account. The conclusion will be again that: for some patients the longer treatment seems better and more research has to be done.

With kind regards,

Ben Naafs