The risk of leprosy in patients using immunobiologics and conventional immunosuppressants for the treatment of dermatological and rheumatological diseases: a cohort study

Infliximab in leprosy type 1 reaction: a case report

“…Although steroids are considered the standard treatment for acute nerve damage, there are lacking evidence of their long‐term effectiveness, 8 and efforts are being made to explore new therapeutic options. Moreover, corticosteroids are associated with a greater risk to develop or worsen leprosy than anti‐TNFα 9 . In one patient with no induced immunosuppression, the use of steroids even worsened his reversal reaction, therefore they should be closely monitored.…”

Infections in the era of immunobiologicals

“…Corticosteroid use has been associated with an increased risk of leprosy, and anti-TNF use has been associated with a lower risk of leprosy when compared to corticosteroids. 66 …”

New insights at the interface between leprosy and immune-mediated rheumatic diseases

“…High degree of immunosuppression was a significant risk factor for leprosy development (HR = 7.9; 95% CI = 1.5–41). Of note, iTNF were associated with significantly lower risk of leprosy compared to corticosteroids (RR = 0.09, 95% CI = 0.02–0.4) ( 92 ).…”

“…Similarly, Gomes et al in the aforementioned longitudinal study of patients with rheumatic and dermatological diseases, also noted that no participant under immunosuppression exhibited leprosy reactions. Moreover, during the follow-up, two cases showed improvement in leprosy manifestations after initiation of biologics: one case had improvement in neuritis while on rituximab (anti-CD20), and another one had type 1 reactions controlled under secukinumab (anti-IL-17A) ( 92 ). The authors concluded that immunosuppression by different mechanisms of action, including biologics, seemed effective in controlling leprosy reactions.…”