Apremilast in multibacillary leprosy patients with chronic and recurrent erythema nodosum leprosum: a prospective single‐centre pilot study

Narang, Tarun; Ashraf, Raihan; Kaushik, Akanksha; Dogra, Sunil

doi:10.1111/jdv.17585

Cited by 8 publications

(9 citation statements)

References 10 publications

(8 reference statements)

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“…There was a significant fall in the Erythema Nodosum Leprosum International Study (ENLIST) score from baseline at Months 1 and 6. After stopping corticosteroid, 6 of the 11 patients (54.5%) remained in remission while 3 (27.2%) had recurrence, but with reduced severity (mean ENLIST score 5.33) and required additional doses of prednisolone 53,54 . Similar findings were reported in another case series that included two patients with chronic ENL 54 .…”

Section: Off‐label Dermatological Uses Of Apremilastsupporting

confidence: 79%

Evolving utility of apremilast in dermatological disorders for off-label indications

Mehta

Sharma

Dogra

2022

Clinical and Experimental Dermatology

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Apremilast, a small molecule that acts by inhibition of the phosphodiesterase‐4 enzyme, has been approved by the US Food and Drug Administration for the management of psoriatic arthritis, plaque psoriasis and Behçet disease. The drug has drawn much interest from practising dermatologists in view of its exceptional safety profile and prescription convenience, as evident by the recent surge of literature describing its off‐label indications. This review was carried out with the aim of summarizing the literature on off‐label use of apremilast in dermatology, in order to guide clinicians regarding currently available evidence. The PubMed database was searched using ‘apremilast’ as a keyword in the title. Abstracts were individually screened to determine whether there was a description of an off‐label use of apremilast in dermatology within the article. Randomized controlled trial data were available for vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Owing to its broad spectrum of immunomodulatory activity, apremilast may be useful in several chronic inflammatory skin diseases recalcitrant to conventional therapies, either alone or in combination with other drugs. Further studies are needed to establish its role in various dermatological indications.

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Section: Off‐label Dermatological Uses Of Apremilastsupporting

confidence: 79%

Evolving utility of apremilast in dermatological disorders for off-label indications

Mehta

Sharma

Dogra

2022

Clinical and Experimental Dermatology

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“…Presenting symptoms have been reported in numerous studies and included weakness [ 10 ], anhidrosis and dryness [ 10 ], eyebrow hair loss [ 11 ], eye closure weakness [ 12 ], a collapsed nose [ 13 ], edema [ 14 ], erythema nodosum [ 15 ], numbness [ 16 ], loss of sensation [ 10 ], pain [ 17 ], pruritus [ 18 ], muscle atrophy [ 19 ], and claw hand deformity [ 20 , 21 ]. Initially, the small sensory and autonomic nerve fibers in the skin are damaged, causing local loss of hair, an inability to sweat and difficulty detecting temperature and touch sensations.…”

Section: Discussionmentioning

confidence: 99%

Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study

2021

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Background Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis. Methodology/Principal findings In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms. Conclusions Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.

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“…Other therapeutic alternatives such as pentoxifylline and apremilast (16 cases), an oral phosphodiesterase-4 inhibitor sharing a common molecular structure with thalidomide, seem to avoid recurrence and allow GCs-sparing [15,[40][41][42][43] Lastly, some case series concerning the value of biotherapies such as TNF-α inhibitors have recently been published. One review identified 4 published cases of refractory ENL effectively treated with a TNF-α inhibitor (infliximab or etanercept) [14].…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

Methotrexate as a corticosteroid-sparing agent in leprosy reactions: A French multicenter retrospective study

et al. 2023

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Introduction Leprosy reactions (LRs) are inflammatory responses observed in 30%-50% of people with leprosy. First-line treatment is glucocorticoids (GCs), often administered at high doses with prolonged courses, resulting in high morbi-mortality. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. In this study, we describe the efficacy, GCs-sparing effect and safety of MTX in LRs. Methods We conducted a retrospective multicentric study in France consisting of leprosy patients receiving MTX for a reversal reaction (RR) and/or erythema nodosum leprosum (ENL) since 2016. The primary endpoint was the rate of good response (GR) defined as the complete disappearance of inflammatory cutaneous or neurological symptoms without recurrence during MTX treatment. The secondary endpoint was the GCs-sparing effect, safety and clinical relapse after MTX discontinuation. Results Our study included 13 patients with LRs (8 men, 5 women): 6 had ENL and 7 had RR. All patients had had at least one previous course of GCs and 2 previous treatment lines before starting MTX. Overall, 8/13 (61.5%) patients had GR, allowing for GCs-sparing and even GCs withdrawal in 6/11 (54.5%). No severe adverse effects were observed. Relapse after MTX discontinuation was substantial (42%): the median relapse time was 5.5 months (range 3–14) after stopping treatment. Conclusion MTX seems to be an effective alternative treatment in LRs, allowing for GCs-sparing with a good safety profile. Furthermore, early introduction during LRs may lead to a better therapeutic response. However, its efficacy seems to suggest prolonged therapy to prevent recurrence.

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Apremilast in multibacillary leprosy patients with chronic and recurrent erythema nodosum leprosum: a prospective single‐centre pilot study

Cited by 8 publications

References 10 publications

Evolving utility of apremilast in dermatological disorders for off-label indications

Evolving utility of apremilast in dermatological disorders for off-label indications

Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study

Methotrexate as a corticosteroid-sparing agent in leprosy reactions: A French multicenter retrospective study

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