Thursday, May 9, 2019

(LML) Tapering prednisolone

Leprosy Mailing List – May 9,  2019

Ref.:  (LML)   Tapering prednisolone

From:  Wim Brandsma, Hoevelaken, the Netherlands

Dear Pieter,

Prednisolone is used in the prevention and treatment of leprosy neuropathy (reactions). There is no consensus or evidence-based recommendation about dose and duration of treatment.

Generally speaking, a course for the 'average' patient may start in the range of 40-60 mg and is then tapered over a period of 4-6 months.  Many patients 'relapse' when doses are tapered or relapse following weeks/ months after cessation of treatment. The dose may be increased again, or a new course given, before tapering may be started again.

NN, 71 at time of diagnosis with a relatively rare rheumatic condition, RS3PE (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) somewhat overlapping with Polymyalgia Reumatica.

Course of treatment: Prednisolone with very promising cure rates:

  • Starting dose 15 mg, tapered to 10mg in a period of 2 months. Then, tapering 10 to 7.5mg  in a 7 week period adding one day of each week of 7.5 mg.
  • This is being followed by another 7 week period tapering from 7.5 to 5 mg. Same practice. Each week adding one day of 5 mg ending the last week with 5mg for all week days. NN is still under treatment but further tapering is then expected to follow. Total treatment period expected to be approx. 10-11 months.

Above case study begs the following questions – fully aware that there are no 'standard' leprosy reactions and that two different diseases are discussed but:

  • Are immunological 'reactions', inflammatory pathways, in above disease (rheumatic conditions generally) different from those know in leprosy?
  • Should tapering of prednisolone in leprosy reactions/neuropathy follow the practice in (some) rheumatic conditions e.g. gradual tapering over a much longer extended period then is usually practiced?

Thank you in advance for your reaction,

Wim

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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