Biologics in Leprosy: A Systematic Review and Case Report

Abstract

Tumor necrosis factor (TNF)-α inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-α inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-α inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNFα inhibitors. Finally, TNF-α inhibitors appear effective in some cases of refractory ENL.

Lesão neural hansênica: Papel da neurotrofina NGF e da citocina TNFα

“…Ao analisar lesões neurais e o epitélio de revestimento da pele, foram observados baixos níveis de NGF e a perda de fibras nociceptivas foi associada a depleção desse fator. Logo, os níveis desse fator e consequentemente a quantidade do seu receptor de alta afinidade (TkrA) se alteram de acordo com as apresentações clínicas da hanseníase, uma vez que altos níveis foram observados na forma lepromatosa e baixos níveis na forma tuberculoide (Cogen et al, 2020). O NGF é descrito como um sinergista de ação redutora do dano tecidual em lesões neurais nas reações hansênicas promovendo regeneração ou apoptose de oligodendrócitos, células de Schwann e neurônios.…”

Infliximab in leprosy type 1 reaction: a case report

“…Although more expensive than corticosteroids, anti‐TNFα are increasingly used in developing countries. Infliximab and etanercept have already shown efficacy in ENL management 10 . When comparing secukinumab to prednisolone in RR, Debdeep reported similar efficacy and recurrence rates but fewer side effects, meaning secukinumab could be used as an alternative to prednisolone 11 .…”

Can etanercept be an option in management of recurrent steroid-dependent erythema nodosum leprosum? A retrospective study of six patients

“…5,6 Tumour necrosis factor inhibitor biologicals have been reported to be effective in management of erythema nodosum leprosum in few reports. [7][8][9][10][11] Faber et al showed good and sustained response in one patient of erythema nodosum leprosum following three doses of infliximab. 8 We chose etanercept due to its easy availability in our hospital low treatment cost.…”