Cargando…

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

BACKGROUND: 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 m...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643133/
https://www.ncbi.nlm.nih.gov/pubmed/28976976
http://dx.doi.org/10.1371/journal.pntd.0005952
_version_ 1783271475306823680
author 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
author_facet 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
author_sort Wagenaar, Inge
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
format Online
Article
Text
id pubmed-5643133
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-56431332017-10-30 Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial 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 PLoS Negl Trop Dis Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Public Library of Science 2017-10-04 /pmc/articles/PMC5643133/ /pubmed/28976976 http://dx.doi.org/10.1371/journal.pntd.0005952 Text en © 2017 Wagenaar et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
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
Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial
title Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial
title_full Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial
title_fullStr Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial
title_full_unstemmed Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial
title_short Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial
title_sort effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: a randomized controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643133/
https://www.ncbi.nlm.nih.gov/pubmed/28976976
http://dx.doi.org/10.1371/journal.pntd.0005952
work_keys_str_mv AT wagenaaringe effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT posterik effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT brandsmawim effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT bowersbob effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT alamkhorshed effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT shettyvanaja effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT paivivek effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT husainsajid effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT sigitprakoeswacitarosita effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT astarilinda effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT haggedeanna effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT shahmahesh effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT neupanekapil effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT tamangkrishnabahadur effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT nichollspeter effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial
AT richardusjanhendrik effectivenessof32versus20weeksofprednisoloneinleprosypatientswithrecentnervefunctionimpairmentarandomizedcontrolledtrial