Leprosy Mailing List – June 6th, 2007
Ref.:
Zafirlukast
From:
Butlin R., Bangladesh
Danish Bangladesh Leprosy Misison Hospital
4 June 2007
Dear Dr Noto,
Use of leukotrinene inhibitors in ENL
reaction.
In Bangladesh we do not have access to
thalidomide and loose clofazimine is in short supply, therefore we
have a strong incentive to explore the possible use of alternative
second line drugs for patients with chronic or severe ENL reaction.
In response to a Letter to
the Editor in International Journal of Leprosy (1) in 1999 (describing
zafirlukast use in a mixed group of type 1 and type 2 reaction cases),
we decided to investigate the use of leukotrine inhibitors for ENL
reaction and now have a formal trial in progress to assess the effect
of Montelukast for ENL reaction.
This is a joint effort between Damien Foundation and The
Leprosy Mission.
While preparing for the trial we have used
zafirlukast “off label” in selected cases, with encouraging
results. At DBLM hospital
(run by The Leprosy Mission) over the past 3 years we treated 10
patients (suffering from ENL) with zafirlukast, for periods of 2-16
weeks. They were
monitored for haematological or biochemical changes (liver function
and renal function tests) as well as clinically. All cases studied were highly
smear positive (BI>3+) and all except one case, newly diagnosed,
were already released from treatment after fixed duration
multibacillary multi-drug
therapy (MBMDT) of 12 months or 24 months.
In all cases there was apparently a
favourable response, and only 1 case had to discontinue the drug
because of an adverse effect (pharyngitis).
Two cases had major
contra-indications to prednisolone and received only zafirlukast but
improved symptomatically. The
other 8 received zafirlukast with prednisolone and were able to
tolerate a lower dose of prednisolone than they had needed before the
zafirlukast was given.
Although there is as yet little
information available about the mechanism of action in leprosy, it
appears that leukotriene inhibitors such as zafirlukast and
montelukast are good candidates for consideration where a
“second line drug” (other than thalidomide or clofazimine) is
needed for ENL reaction.
Yours sincerely,
C Ruth Butlin
(1) Eduardo A Vides, Alwys Cabrera,
Kathleen Ahern, William R Levis. “Effect of zafirlukast on leprosy
reactions.” IJL 67, 1999, p 71-75
