British Leprosy Relief Association
RaoP. S. S. Sundara
SugamaranD. S. T.a
SmithW. C. S.b
aSchieffelin Leprosy Research and Training Centre, Karigiri, Tamil Nadu 632106, India
bDepartment of Public Health, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
Correspondence to: W. C. S. Smith (Tel: +44 1224 553802; Fax: +44 1224 550925; e-mail: firstname.lastname@example.org)
Contributors: Dr Rao contributed to the design, conduct, monitoring, co-ordination, data analyses and writing up of this study. He also performed and managed the trial randomization. Dr Sugamaran contributed to the staff training, trial monitoring, quality assurance, co-ordination and the drafting of the paper. Dr Richard contributed to the blinding, analysis, data analysis and the writing of the paper. Dr Smith contributed by advising on the design, conduct, analysis and in drafting and preparing the paper and as corresponding author. None of the authors has any competing interest.
The objective of this randomized trial was to compare three different steroid regimens in treating type 1 reactions in leprosy in routine clinical practice.
The study design was a multicentre, double-blind, randomized, controlled, parallel group trial in patients with acute reversal reactions. The trial was conducted in six leprosy treatment centres in India. A total of 334 participants with acute type 1 reaction were recruited to the trial and randomized to one of three prednisolone regimens: high dose (60 mg per day) or low dose (30 mg per day) both tapered over 20 weeks, and short duration (60 mg per day tapered over 12 weeks). The main outcome measure was the proportion of patients failing to respond to treatment and requiring additional steroids.
At the end of 12 months, 46% on the short course required additional steroids compared with 31% on the low dose and 24% on the high dose regimen.
The two 20-week regimens were significantly better than the 12-week regimen. The high dose 20-week regimen was marginally and non-significantly better than the low dose regimen, but the high dose regimen contained 50% more steroid. Reactions in leprosy persist over many months and require long courses of steroids.