Summary of the published reports on the use of cyclosporine

Leprosy Mailing List –  February 26^th, 2011

Ref:    Summary of the published reports on the use of cyclosporine

From: Scollard D., Baton Rouge , LA , USA  

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Salvatore,

In response to Antonio’s question, here is a summary of the published reports on the use of cyclosporine from our review in 2006.  The references for its use in ENL are given below the table.

Best wishes,

David

David M. Scollard, M.D., Ph.D.

Chief, Clinical Branch

National Hansen’s Disease Programs

1770 Physician Park Dr .

Baton Rouge , LA   70816

Tel:  225-756-3713

FAX:  225-756-3819

e-mail:  DScollard@hrsa.gov

Web:  www.hrsa.gov/hansens

Source:

CLINICAL MICROBIOLOGY REVIEWS, Apr. 2006, p. 338–381 Vol. 19, No. 2.  .338–381, 2006

The Continuing Challenges of Leprosy

D. M. Scollard,* L. B. Adams, T. P. Gillis, J. L. Krahenbuhl, R. W. Truman, and D. L. Williams

Laboratory Research Branch, National Hansen’s Disease Programs,

Louisiana State University-SVM, Baton Rouge , Louisiana 70803

Table 8.  Effects of Immunosuppressive Agents on Leprosy Reactions.

Agent	Primary Mechanisms of Action	Effect on Type 1 Reaction	Effect on Type 2 Reaction
Thalidomide	Multiple dose-related mechanisms: inhibits TNF,  stimulates IL-2, inhibits IgM response   (333, 362)	0 (166)	++++   (275, 276, 367, 404)
Methotrexate	Anti-metabolite inhibiting lymphoid and myeloid proliferation (56)	nd a	++   (202)
Cyclosporin A	Inhibits IL-2 and other cytokines (27, 147, 211, 250)	++  (64. 116, 421)	+/-   (226, 261, 283, 418, 421)
Azathioprine	Purine antagonist;  inhibits lymphocyte proliferation;  exact mechanism unknown (27, 147)	+b                  (246)	+ b  (243)
Pentoxifylline	Inhibits TNF and other cytokines (321, 395)	+/-  (82, 275)	+/- (82, 276, 287,  331)
Mycophenolate mofetil	Blocks guanosine nucleotides, inhibiting proliferation of T- and B-cells (27, 147)	nd a	0 (47)
Corticosteroids	Blocks transcription factors AP-1 and NF6B;   Inhibit synthesis of many pro-inflammatory cytokines  (203, 341)	++++         (283)	+++            (276)

1. nd = no data available
2. Effect observed only in combination with prednisolone
   (References are enclosed in parentheses)

Kumar, B., S. Dogra, and I. Kaur. 2004. Epidemiological characteristics of leprosy reactions: 15 years experience from north India . Int J Lepr Other Mycobact Dis72:125-33.

  Miller, R. A., J. Y. Shen, T. H. Rea, and J. P. Harnisch. 1987. Treatment of chronic erythema nodosum leprosum with cyclosporine A produces clinical and immunohistologic remission. Int J Lepr Other Mycobact Dis 55:441-9.

  Naafs, B. 2003. Treatment duration of reversal reaction: a reappraisal. Back to the past. Lepr Rev 74:328-36.

  Uyemura, K., J. F. Dixon, L. Wong, T. H. Rea, and R. L. Modlin. 1986. Effect of cyclosporine A in erythema nodosum leprosum. J Immunol 137 :3620-3.

  van Gompel, A., E. van den Enden, and J. van den Ende. 1994. Cyclosporin A is not very effective in erythema nodosum leprosum (ENL). Trop Geogr Med 46:331.