Evaluation of steroids efficacy in preventing and reversing nerve function impairment in multibacillary leprosy cases

Objectives: This study was to assess the utility of steroids to prevent reactions, neuritis and nerve function impairment in multibacillary cases of leprosy and also aimed to see if the use of steroids reversed the nerve function impairment. Materials and Methods: The study involved 40 cases with multibacillary leprosy divided into two groups. Group A consisted of prophylactic and therapeutic steroids subgroups. The prophylactic steroid group received WHOMDTMB for 12 months with prednisolone, 20 mg/day for 3 months which was tapered off in the 4 months, while the therapeutic steroid group received MDT-MB with higher doses of prednisolone (40mg per day starting dose, tapered off every 14 days). Group B received only WHOMDT-MB for 12 months. The study assessed clinical parameters to diagnose reactions and nerve function impairment. Silent neuritis was diagnosed when in the absence of clinical symptoms and signs, there was nerve function impairment (NFI). NFI was assessed with touch sensibility test (TST) done with Semmes- Weinstein monofilaments of nylon, voluntary muscle test (VMT) as per modified MRC grade and nerve conduction velocity (NCV) assessments. All the cases were followed up till completion of MDT clinically every month and with TST, VMT and NCV done at 3 monthly intervals. The cases were followed up every 3 months for a further period of 1 year post release from treatment (RFT). A skin biopsy was done in cases presenting with skin lesions. In cases with pure neural leprosy, a cutaneous nerve biopsy was done. The baseline biopsies were done to confirm the diagnosis by histopathology and classify the patient histologically. Results: We observed that in Group A, 2 out of 18 patients had neuritis, and both baseline neuritis, while in Group B, 3 out of 22 exhibited a type I reaction along with neuritis. That means the 2 cases in Group A who developed repeat neuritis despite receiving therapeutic dose of prednisone earlier. While majority of them (16/18) didn’t get reaction or neuritis. Occurrence of Type 1 reaction and neuritis was seen in 3/22 cases in the group B. TST and VMT improved in 1 case in Group A while TST deteriorated in 2 cases in Group B suggesting the efficacy of steroids in the steroid group. Conclusion: This means our study shows benefits of steroids in preventing reactions/nerve damage in leprosy. It also shows efficacy of steroids in preventing NFI.