Title:Leprosy Reactions: Clinical Pharmacologist Perspective with Repurposed
Medications
Volume: 23
Issue: 2
Author(s): Pugazhenthan Thangaraju*, Aravind Kumar Balan, Hemasri Velmurugan, Sajitha Venkatesan and Sree Sudha Tanguturi Yella
Affiliation:
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
Keywords:
Hypersensitivity reaction, leprosy neuritis, anti-leprosy drugs, newer drugs, biomarkers, plasma exchange.
Abstract: The elimination of leprosy has been possible with the available anti-leprotic drugs. However,
the lepra reactions usually occur months or years after multi-drug therapy completion, and continue
to be a formidable challenge mainly owing to its role in causing nerve damage and disability. Corticosteroids
are commonly used but they lead to systemic complications, and hence require dose reduction
and adjunct therapy with a different target. Various drugs with different targets have been identified
and are in practice to treat lepra reactions. The newer targets can include genetic and tissue targets in
the skin and nerve. Thalidomide treatment reducing pentraxin-3, toll-like receptor antagonists, minocycline,
apremilast, immunomodulators, and tenidap can be helpful in lepra reaction. Other modalities
to manage lepra reactions include plasma exchange, intravenous immunoglobulins, and immunotherapy.
Most of these treatments are based only on the pathological process of the reaction and tend to be
incomplete leading to recurrence. Newer multimodal approaches are required based on various biomarkers
(genetic, tissue, serological), which can be monitored to prevent the recurrence of reactions.
Hence, there is a need for newer targets and drugs to be identified for the management of lepra reactions.
