Successful treatment of erythema nodosum leprosum with apremilast

Abril‐Pérez, Carlos; Palacios-Diaz, Rodolfo David; Navarro‐Mira, Miguel Ángel; Botella‐Estrada, Rafael

doi:10.1111/dth.15258

Cited by 2 publications

(1 citation statement)

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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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