Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Abstract

Introduction: Thalidomide is an anti-tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. Methods: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. Results: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. Conclusions: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.

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

“…It is a difficult condition to manage as patients require prolonged courses of high-dose prednisolone with risks of adverse effects (AEs), such as hypertension, diabetes or osteoporosis and steroid dependency along with immunosuppression. 1 Steroid sparing agents such as thalidomide, 2 clofazimine, minocycline, cyclosporine, pentoxifylline, azathioprine and methotrexate have been used with variable success rates.…”

A Young Female With Borderline Lepromatous Leprosy and Tuberculous Lymphadenitis: A Rare Coinfection

“…When patients do not respond to either clofazimine or clofazimine and prednisolone, thalidomide is explored. Additionally, in the treatment of ENL, thalidomide should be administered in conjunction with steroids in a dosage range of 100 to 400 mg as a split dose in cases of neuritis [16]. Dapsone-induced hemolytic anemia, a frequent adverse drug reaction in leprosy patients taking daily dapsone dose, is often addressed by discontinuing the drug; however, in those cases, ofloxacin or minocycline may be given to patients as an alternate therapy [17].…”

Thalidomide—Then and Now: Case Report of a Woman With Thalidomide Embryopathy and Review of Current Thalidomide Uses

“…Several systemic and dermatologic conditions may potentially be treated with thalidomide (Table 1) [4][5][6][7][8][9][10][11][12][13][14][15][16].…”