Leprosy mailing list – October 16th,
2006
Ref.: Pentoxifylline
in the
treatment of ENL reaction
From: de
Carsalade G., Mayotte island, Indian Ocean
Dear Dr Strahm,
I refer to your message dated
LML Sep. 27th, 2006. In
Mayotte island, French territory in the Indian Ocean with prevalence
of leprosy 4,47/10 000 population since 5 years we use
pentoxifylline (Torental) to treat ENL in the first intention. Initially we give 400mg three
times a day for one month, and then when all subcutaneous nodules have
disappeared we decrease slowly by step of 400mg/month. If there is no response at all
after 15 days of treatment we try prednisone.
Over than 25 patients of ENL (more 50 ENL
episodes) we had only 2 patients who didn’t improve. The fever, asthenia,
arthralgia disappear in about ten days.
The cutaneous lesions need at minimum three weeks before seeing
improvement and disappear completely after two months. This treatment used by other
teams (Brazil, India) is slight less rapid than corticosteroid
especially on cutaneous lesions but almost as efficient as
corticosteroid about fever, arthralgia, and asthenia. There is sometimes a new
episode of ENL like with corticosteroids or thalidomide and each
time a new treatment of pentoxifylline is efficient. The great advantage of
this treatment is to avoid corticosteroid during a long time (pentoxifylline
for a few month is without severe side effect). No severe side effects except gastrointestinal
pain the most often which disappears under treatment, no risk of
teratogenicity, and the cost because it is an old drug. Several articles have
been published about this.
The main problem
(especially for you in this case) is that the patient under
corticosteroid for a long time (cortico-dependant ENL) seems to
answer more difficultly or not at all at this treatment. In this case you may introduce
pentoxifylline and begin to decrease corticoid after one
month and step after step.
Yours sincerely,
Dr
Gy de Carsalade
