Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial.

Abstract

BACKGROUND:

While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function.

METHODS:

In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the Reaction Severity Scale, the SALSA Scale and the Participation Scale. Serious Adverse Events and the need for additional prednisolone treatment were monitored and reported.

RESULTS:

We included 868 patients in the study, 429 in the 20-week arm and 439 in the 32-week arm. At 78 weeks, the proportion of patients with improved or restored nerve function did not differ significantly between the groups: 78.1% in the 20-week arm and 77.5% in the 32-week arm (p = 0.821). Nor were there any differences in secondary outcomes, except for a significant higher proportion of Serious Adverse Events in the longer treatment arm.

CONCLUSION:

In our study, a 20-week course of prednisolone was as effective as a 32-week course in improving and restoring recent clinical NFI in leprosy patients. Twenty weeks is therefore the preferred initial treatment duration for leprosy neuropathy, after which likely only a minority of patients require further individualized treatment.

• Authors: Inge Wagenaar, Erik Post, Wim Brandsma, Bob Bowers, Khorshed Alam, Vanaja Shetty, Vivek Pai, Sajid Husain, Cita Rosita Sigit Prakoeswa, Linda Astari, Deanna Hagge, Mahesh Shah, Kapil Neupane, Krishna Bahadur Tamang, TENLEP study group, Peter Nicholls, Jan Hendrik Richardus
• Journal: PLoS neglected tropical diseases (PLoS Negl Trop Dis) Vol. 11 Issue 10 Pg. e0005952 (Oct 2017) ISSN: 1935-2735 [Electronic] United States
• PMID: 28976976 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Anti-Inflammatory Agents
• Prednisolone

Topics

• Adolescent
• Adult
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• Double-Blind Method
• Drug Administration Schedule
• Female
• Humans
• Leprosy (complications, drug therapy)
• Male
• Middle Aged
• Peripheral Nervous System Diseases (drug therapy, etiology)
• Prednisolone (administration & dosage, therapeutic use)
• Young Adult