Leprosy mailing list – October 10th, 2006

 

Ref.:     Treatment of recurrent ENL reaction

From:   Hamid Salim M. A, Banani, Bangladesh

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Dear Dr Stefan Strahm,

 

I refer to your LML message dated 27 September 2006.  Management of patients with repeated ENL reaction is very challenging.  I have several such experiences.  In fact, Thalidomide seems to be the best drug for the management of ENL reaction but in many countries this drug is not officially allowed to use.  To my experience repeated ENL reaction can continue for several years- probably until the body expels all dead bacilli.  Using steroid with high doses repeatedly may lead to serious complications for many patients.  In our projects in Damien Foundation Bangladesh we have treated several cases with repeated ENL reactions with Zafirlucast (Vides et al “Effects of zafirlucast on leprosy reaction” International Journal of leprosy and other mycobacterium diseases. 67, (1999) p71-75,) and for some of the cases we seen excellent results.  So, for this patient you may try tab: Zafirlukast 20 mg b.d. for 16 weeks.

 

Rationale: Knowing that the reactional states are the result of a cytokine imbalance of the immune system, we expect an immunomodulatory drug to suppress reaction in leprosy.  Tumour necrosis factor-a (TNF-a) and interleukin–1 have been implicated as key mediators in leprosy reactional states.  Recently, Calhoun et al. have shown that Zafirlukast is capable of reducing TNF-a and superoxide anions concentration in bronchial lavage fluid of asthmatic patients, stimulated with segmental antigens.  Their rationale was based on the observation that Chan et al. showed monocytic cells express on their surface cysLTD-1 receptors that are inhibited by Zafirlukast.

 

I hope this can be in help.

 

 Best regards,

 

Dr. M A Hamid Salim
Country Director & Medical Advisor
Damien Foundation Bangladesh
Banani Model Town
Road-18, House-24,
Banani –1213,  Bangladesh
Tel: +880 1713011135
dfsalim@citechco.net