Minocycline Effective for Erythema Nodosum Leprosum

By Will Boggs MD

April 28, 2015

NEW YORK (Reuters Health) - Minocycline is effective for treating recurrent and chronic erythema nodosum leprosum (ENL), according to a pilot study in 10 patients with multibacillary leprosy.

"We were surprised when we saw the response in a few of our patients with chronic ENL, who also had clinical resistance/nonresponsiveness to multidrug therapy," Dr. Sunil Dogra, from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, told Reuters Health by email.

"We think that it can be used in all patients with recurrent/chronic ENL with high bacterial index, where we are unable to taper corticosteroids or where relapses occur within four to six weeks of stopping steroids," Dr. Dogra said.

Dr. Dogra and colleagues gave minocycline 100 mg/day for up to three months, along with gradual tapering of the prednisolone regimen to discontinuation, to five patients with recurrent ENL, four with chronic corticosteroid-dependent ENL, and one with chronic corticosteroid- and thalidomide-dependent ENL.

They successfully tapered the prednisolone regimen without relapse in three patients after four weeks of treatment and in five additional patients after eight weeks of treatment with minocycline.

These eight patients completely discontinued prednisolone after 16 to 18 weeks of tapering. In one year of follow-up, only two patients had recurrence of mild ENL that responded to rest and acetaminophen.

Adverse effects included hyperpigmentation in all 10 patients, gastric pain in two patients, and vomiting and mild transaminitis in one patient each, according to the April 15 JAMA Dermatology online research letter.

Twelve weeks of therapy costs only $30 per patient, the researchers note.

"The response with minocycline may not be as fast as corticosteroids or thalidomide, so it has to be combined with these drugs initially, and the majority of our patients started showing response and we were able to taper steroids by four to six weeks," Dr. Dogra said. "So an adequate trial (six to eight weeks) should be given before changing over to other therapies, or maybe higher doses can be given in some patients."

Dr. Azeen Sadeghian, from Tulane University, New Orleans, Louisiana, recently coauthored a case report of lepromatous leprosy associated with ENL in a 41-year-old man. She told Reuters Health by email, "It has been shown that minocycline can reduce levels of TNF (tumor necrosis factor) alpha. Also, minocycline has recently been evaluated in neurological conditions to determine if it could be neuroprotective and there has been some success. These properties could contribute to its efficacy."

"Although tetracyclines have long been known to have anti-inflammatory properties, minocycline is the only one to have intrinsic activity against M. (Mycobacterium) leprae making it more appealing for managing ENL," Dr. Sadeghian said.

The authors reported no external funding or disclosures.

SOURCE: http://bit.ly/1DCwXDY

JAMA Dermatol 2015.

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