Leprosy Mailing List – December 25, 2013
Ref.: (LML) Thalidomide in treating kidney involvement in ENL
From: Jingquan Wang, Zhejiang, China
Dear Pieter Schreuder and Ben Naafs,
Thanks for Dr Ben Naafs quick response and good comment on Dec 20,2013.The female patient has improved in kidney function. The recent routine urine test showed the erythrocytes in the urine had disappeared and leucocytes in the urine still present with 26 leucocytes(normal:0-10). Although we did not take any culture, we still concluded that the patient accompanied with urinary tract infection, besides the ENL inflammation in the kidney. We will prescribe new drugs such as minocycline (some experts say it has the effect to control ENL) to treat the infection with over 7 days. While the patient was on treatment for ENL and urinary tract infection, the patient had no colic pains and ureter stones can be excluded. On admission day, the urine test showed no any leucocyte or erythrocyte in the urine besides albuminuria.
In my experience, triptolide is a good drug to relieve nerve pains and kidney damage, which is widely used to treat moderate to severe ENL cases or those steroid dependent ENL cases. Triptolite combined with prednisone has a long history of treating ENL in China since 1970s. Dr. Shen Jianping and Dr. Yan Liangbin made a trial to compare the effects of group triptolide alone (A) and group of triptolide and prednisone combination (B)T. The dosage of triptolide in two groups was 60-80 mg daily for four weeks in the hospital and then tapered the dosage for another four weeks at home. The patients in group B received prednisone besides the same triptolide as in group B. The results showed there was no differences in symptoms, improvement and recurrence rate ENL between two groups. The general score of clinical status for 18 patients in group A decreased from 10.94 to 0.94 (4 weeks) and 1.44(8 weeks). The general scores for 16 patients in group B from 13.19 to 1.63 (4w) and 2.25 (8w). The recurrence ENL rates of two groups were both 50%, with an interval time of 7-60 days from stopping treatment or gradual reduction in group A and 7-20 days from the gradual of triptolide 30-40 mg daily in group B. There were additional 2 patients who could not tolerate the drug (severe vomiting and nausea) and dropped out the study. The remaining 34 ENL cases finished the study, with only one patient with mild nausea. The authors concluded that triptolide has a significant efficacy in treating ENL and it is necessary to make out a very slow tapering regimen to prevent ENL from recurrency.
By the way, how to define a chronic ENL case, of 3 months or 6 months duration? I feel that recurrent ENL cases were more common in China and chronic or continuous ENL cases lasting 2-3 years are relatively rare. Do you agree with me? I am very surprised why ILEP technical report of Issue No 9, revised April 2011 do not include the regime of thalidomide +prednisone regime and do not give the advice on chronic ENL treatment? It is a great default. Have anyone in LML circle participated in developing the advice?
Best regards.
Jingquan Wang,
Chief physician
Institute of Dermatology of Zhejiang Province,
China,313200
E-mail:Jingquanwang.cn@hotmail.com
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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