Management of Type I reaction (reversal reaction)

Leprosy Mailing List – May 13^th, 2011 

Ref:    Management of Type I reaction (reversal reaction)

From: P. Saunderson, Greenville, SC, USA

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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