Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial.
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 mor...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-10-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | http://europepmc.org/articles/PMC5643133?pdf=render |
| _version_ | 1818288780678791168 |
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| author | Inge Wagenaar Erik Post Wim Brandsma Bob Bowers Khorshed Alam Vanaja Shetty Vivek Pai Sajid Husain Cita Rosita Sigit Prakoeswa Linda Astari Deanna Hagge Mahesh Shah Kapil Neupane Krishna Bahadur Tamang TENLEP study group Peter Nicholls Jan Hendrik Richardus |
| author_facet | Inge Wagenaar Erik Post Wim Brandsma Bob Bowers Khorshed Alam Vanaja Shetty Vivek Pai Sajid Husain Cita Rosita Sigit Prakoeswa Linda Astari Deanna Hagge Mahesh Shah Kapil Neupane Krishna Bahadur Tamang TENLEP study group Peter Nicholls Jan Hendrik Richardus |
| author_sort | Inge Wagenaar |
| collection | DOAJ |
| description | 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.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.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.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. |
| first_indexed | 2024-12-13T02:01:49Z |
| format | Article |
| id | doaj.art-f0c9670205b24fe7b3d4199388054b07 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-12-13T02:01:49Z |
| publishDate | 2017-10-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-f0c9670205b24fe7b3d4199388054b072022-12-22T00:03:15ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352017-10-011110e000595210.1371/journal.pntd.0005952Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial.Inge WagenaarErik PostWim BrandsmaBob BowersKhorshed AlamVanaja ShettyVivek PaiSajid HusainCita Rosita Sigit PrakoeswaLinda AstariDeanna HaggeMahesh ShahKapil NeupaneKrishna Bahadur TamangTENLEP study groupPeter NichollsJan Hendrik RichardusWhile 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.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.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.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.http://europepmc.org/articles/PMC5643133?pdf=render |
| spellingShingle | Inge Wagenaar Erik Post Wim Brandsma Bob Bowers Khorshed Alam Vanaja Shetty Vivek Pai Sajid Husain Cita Rosita Sigit Prakoeswa Linda Astari Deanna Hagge Mahesh Shah Kapil Neupane Krishna Bahadur Tamang TENLEP study group Peter Nicholls Jan Hendrik Richardus Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial. PLoS Neglected Tropical Diseases |
| 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 |
| url | http://europepmc.org/articles/PMC5643133?pdf=render |
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