Thalidomide and Brazil

 

Leprosy Mailing List – July 31,  2013 

Ref.:    (LML)  Thalidomide and Brazil

From:  Jaison Barreto, ILSL, Bauru, São Paulo, Brazil

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Dear Pieter

 

In our Institute ILSL in Bauru, which is a National Leprosy Referral Centre, we have a lot of experience regarding Thalidomide and the treatment of ENL. Thousands of patients have been taken this drug for type 2 reactions. In most instances, this is a life saver, as posted by Dr Lockwood. We never had a birth defect due to this drug reported, despite the attendance of 400 ENL cases every year. I recommend the article written by our professor (in memorian), Dr Opromolla, about thalidomide and ENL (see annex).

 

For those without experience of using teratogenic drugs, like methotrexate or systemic retinoids, I agree with the physician (professor) from the state of Rio Grande do Sul: "it is better to be afraid and not prescribe". Nevertheless, I can understand why this physician was so interested in the consequences of this drug in her state, where leprosy was declared eliminated in 1995. Eliminated, partly due to the progressive retirement of most physicians (sanitary dermatologists) who knew what was leprosy. Nowadays, in the state of Rio Grande do Sul, many leprosy suspects must travel up to 600km to be diagnosed, and only after a bacilloscopy has been done (and not always done well).

 

When I was a monitor of LEM - Leprosy Elimination Monitoring, in 2003 and 2005, I visited aImost all regions of the state of Rio Grande do Sul, and observed that most patients were old and were advanced cases. Household contacts were seldom evaluated, due to the presence of extreme stigma and prejudice. Re-infection and/or super-infection were the rule, causing  not controllable reactions.

 

Finally, it is important for all LML readers to know that the Brazilian Government has a rigorous control of  thalidomide prescription in case of leprosy.

 

Regards,

 

Jaison

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LML - S Deepak, B Naafs, S Noto and P Schreuder
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