Minocycline for Recurrent and/or Chronic Erythema Nodosum Leprosum

Narang, Tarun; Sawatkar, Gitesh U.; Kumaran, Muthu Sendhil; Dogra, Sunil

doi:10.1001/jamadermatol.2015.0384

Cited by 23 publications

(30 citation statements)

References 5 publications

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“…While thalidomide is highly teratogenic (with a propensity to produce birth defects if taken during pregnancy) and produces adverse effects like peripheral neuropathy, clofazimine is associated with troublesome skin pigmentation and gastrointestinal side‐effects. Although minocycline has been used in small studies, the drug itself has been reported to precipitate ENL in patients with leprosy by killing Mycobacterium leprae organisms, in addition to causing cutaneous pigmentation …”

Section: Discussionmentioning

confidence: 99%

“…Although minocycline has been used in small studies, the drug itself has been reported to precipitate ENL in patients with leprosy by killing Mycobacterium leprae organisms, in addition to causing cutaneous pigmentation. 8 Apremilast is a U.S. Food and Drug Administration-approved drug used clinically in the management of chronic plaque psoriasis and psoriatic arthropathy. By selective PDE-4 inhibition, it increases intracellular cyclic adenosine monophosphate levels and downregulates multiple inflammatory mediators involved in T helper cell 1 and T helper cell 17 pathways.…”

Section: Discussionmentioning

confidence: 99%

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Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases

2019

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Summary Erythema nodosum leprosum (ENL) is a severe immune reaction commonly encountered as a complication in patients with multibacillary leprosy. Management of chronic ENL in leprosy is challenging and necessitates the use of systemic immunosuppressants, including corticosteroids and thalidomide. No single drug is universally effective and most current therapeutic agents carry a significant risk of systemic toxicity. Apremilast is an orally effective phosphodiesterase‐4 inhibitor with a potent immunomodulatory action and is clinically effective in inflammatory conditions like chronic plaque psoriasis. We report two patients with poorly controlled chronic ENL, despite the use of multiple therapeutic agents. Both patients demonstrated significant clinical improvement with apremilast, without any adverse effects, thereby suggesting its potential as a novel therapeutic option in chronic ENL. What's already known about this topic? Erythema nodosum leprosum (ENL) is an immune‐mediated reaction in patients with multibacillary leprosy, with chronicity and recurrences frequently reported. Management of chronic ENL requires systemic immunosuppressants like corticosteroids, which may not be universally effective and carry a risk of serious toxicity. Apremilast is an oral immunomodulator with good efficacy in inflammatory conditions like chronic plaque psoriasis. What does this study? Apremilast may be an effective therapeutic agent in patients with chronic ENL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases

2019

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“…Recently, two additional cases of E . pasteuriana were reported from Guangzhou, China, in a renal transplant recipient [ 23 ] and in a patient treated with high-dose corticosteroids [ 24 ].…”

Section: A Leap From Obscurity To Global Medical Importancementioning

confidence: 99%

50 Years of Emmonsia Disease in Humans: The Dramatic Emergence of a Cluster of Novel Fungal Pathogens

et al. 2015

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“…17,18 The addition of minocycline to MDT has been shown to be more efficacious than the MDT alone 9 and has been found to impart a better control of reactional episodes. 19,20 There is a dearth of studies assessing the effectiveness of alternative/newer regimens in the management of leprosy in the last few decades. In a prospective study on 21 MB patients using the same alternative regimen as used in the present study, Maia et al 21 found that all patients tolerated the drugs well, with satisfactory compliance, and no events adverse enough to warrant discontinuation of the treatment were noted.…”

Section: Discussionmentioning

confidence: 99%

Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India

Narang

Bishnoi

Dogra

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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A subset of multibacillary (MB) leprosy patients manifest with clinical "nonresponsiveness" to the fixedduration, World Health Organization multidrug therapy MB regimen (WHO-MDT-MBR). The aim of this retrospective study was to assess the effectiveness and safety of alternate anti-leprosy therapy (ALT) in such patients. This is an analysis of patients' records, registered in the leprosy clinic of our institute over a period of 6 years (2010-2015). The criteria for inadequate response/nonresponsiveness to treatment were as follows: 1) persistent/new lesions after completing ³ 12 months of WHO-MDT-MBR (isolated reactions were ruled out histopathologically) and 2) persistent positive/ increasing value of the morphological index (MI) and a 2 log increase in the bacteriological index (BI) after ³ 12 months of WHO-MDT-MBR. Such cases were treated with ALT consisting of minocycline, clofazimine, and ofloxacin (24 months). Of 556 patients registered during the study period, 40.3% (224) were slit-skin smear (SSS) positive and 59.7% (332) were SSS negative. Of all, 35 patients (6.3%) satisfied the criteria for clinical nonresponsiveness. Of 224 SSS-positive patients, these 35 patients amounted to 15.6%. The mean BI and MI of these patients after completion of ³ 12 months of WHO-MDT-MBR were 5.3 ± 0.6 and 14 ± 6.8%, respectively. After 6 months of treatment with ALT, MI became negative (0) in all these patients. After completion of ALT, the mean BI and MI became 1.7 ± 0.7 and 0%, respectively (P < 0.0001). There were 16 patients with corticosteroid-dependent recurrent/chronic erythema nodosum leprosum, who had excellent response with significant reduction in the number of reactional episodes and mean dose of prednisolone required (P < 0.0001). No serious adverse effects were noted. We conclude that ALT is safe and effective in the management of MB leprosy patients who are nonresponsive to 12 months of WHO-MDT-MBR.

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Minocycline for Recurrent and/or Chronic Erythema Nodosum Leprosum

Cited by 23 publications

References 5 publications

Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases

Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases

50 Years of Emmonsia Disease in Humans: The Dramatic Emergence of a Cluster of Novel Fungal Pathogens

Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India

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