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

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 mor...

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Vydáno v:	PLoS neglected tropical diseases Ročník 11; číslo 10; s. e0005952
Hlavní autoři:	Wagenaar, Inge, Post, Erik, Brandsma, Wim, Bowers, Bob, Alam, Khorshed, Shetty, Vanaja, Pai, Vivek, Husain, Sajid, Sigit Prakoeswa, Cita Rosita, Astari, Linda, Hagge, Deanna, Shah, Mahesh, Neupane, Kapil, Tamang, Krishna Bahadur, Nicholls, Peter, Richardus, Jan Hendrik
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 04.10.2017 Public Library of Science (PLoS)
Témata:	Adolescent Adult Analysis Anti-Inflammatory Agents - administration & dosage Anti-Inflammatory Agents - therapeutic use Biology and Life Sciences Body weight Care and treatment Clinical trials Dosage and administration Double-Blind Method Drug Administration Schedule Drug therapy Duration Edema Female Hospitals Humans Impairment Laboratories Leprosy Leprosy - complications Leprosy - drug therapy Male Medicine Medicine and Health Sciences Middle Aged Nerves Nervous system diseases Neuropathy Patients Peripheral Nervous System Diseases - drug therapy Peripheral Nervous System Diseases - etiology Prednisolone Prednisolone - administration & dosage Prednisolone - therapeutic use Public health Randomization Research and Analysis Methods Skeletal muscle Supervision Testing Treatment outcome Tropical diseases Tumor necrosis factor-TNF Young Adult Bangladesh Mumbai India Nepal India
ISSN:	1935-2735, 1935-2727, 1935-2735
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Shrnutí:	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. 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. 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. 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.
Bibliografie:	new_version ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 The authors have declared that no competing interests exist. The members of The TENLEP study group can be found in the “Members of The TENLEP study group” section below.
ISSN:	1935-2735 1935-2727 1935-2735
DOI:	10.1371/journal.pntd.0005952