Leprosy Mailing List Blog: (LML) Steroid Dependency

Leprosy Mailing List – October 19, 2017

Ref.: (LML) Steroid Dependency

From: Barbara M. Stryjewska and John F. Prestigiacomo, Baton Rouge, USA

Dear Pieter,

Thank you, Dr. Grace Warren and Dr Jose Augusto for bringing up the important topic of steroid dependency in the treatment of Leprosy reactions.

We would like to share with LML readers the approach that is taken by the National Hansen's Disease Programs in the United States when steroids are needed for treatment of Type I or Type II reactions.

In order to treat our reaction patients we use a combination of Prednisone and Methotrexate.

For the past several years, we have been adding weekly methotrexate (10mg to 20mg) to the patient's treatment regimen as a steroid sparing drug. Also given is daily folic acid (1mg) to prevent and / or suppress methotrexate side effects.

With many of our patients being diabetic, it is preferable to use the lowest dose of steroid necessary to control their reaction.

Our approach helps us use much lower doses of steroids, prevent steroid dependent complications like glaucoma and prevent steroid withdrawal since our doses in the long term are relatively lower.

Another observation we would like to share is that discontinuation of steroids must be low and slow. We use prednisone and taper the dose by 1 mg every 4 weeks when the patient's steroid dose reaches 5mg per day.

In regards to ENL, the most severe outbreaks that we see are usually due to steroid dose reduction that is done too quickly or when steroids have been abruptly discontinued.

Sincerely,

Barbara

Barbara M. Stryjewska, M. D.

Chief, Clinical Branch

National Hansen's Disease Programs

1770 Physicians Park Drive

Baton Rouge, LA 70816

Ph #: (225) 756-3712

Fax#: (225) 756-3706

bstryjewska@hrsa.gov

NHDP Web Site: http://www.hrsa.gov/hansens-disease/

Online Course: "Awareness of Hansen's Disease in the US"