02884nas a2200385   4500000000100000008004100001260001200042653001200054653001700066653002200083653003300105653002700138100001200165700001000177700001300187700001200200700001700212700001200229700000900241700001500250700001400265700001600279700001200295700001400307700001400321700001300335700001400348700002100362245011500383856009900498300001300597490000700610520186700617022001402484       2023                            d  c04/202310aLeprosy10aMethotrexate10aleprosy reactions10acorticosteroid-sparing agent10aimmunomodulating agent1 aJaume L1 aHau E1 aMonsel G1 aMahé A1 aBertolotti A1 aPetit A1 aLe B1 aChauveau M1 aDuhamel E1 aMaisonobe T1 aBagot M1 aBouaziz J1 aMougari F1 aCambau E1 aJachiet M1 atransmissibles G00aMethotrexate as a corticosteroid-sparing agent in leprosy reactions: A French multicenter retrospective study.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011238&type=printable  ae00112380 v173 a<p><strong>Introduction:</strong> Leprosy reactions (LRs) are inflammatory responses observed in 30%-50% of people with leprosy. First-line treatment is glucocorticoids (GCs), often administered at high doses with prolonged courses, resulting in high morbi-mortality. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. In this study, we describe the efficacy, GCs-sparing effect and safety of MTX in LRs.</p>

<p><strong>Methods:</strong> We conducted a retrospective multicentric study in France consisting of leprosy patients receiving MTX for a reversal reaction (RR) and/or erythema nodosum leprosum (ENL) since 2016. The primary endpoint was the rate of good response (GR) defined as the complete disappearance of inflammatory cutaneous or neurological symptoms without recurrence during MTX treatment. The secondary endpoint was the GCs-sparing effect, safety and clinical relapse after MTX discontinuation.</p>

<p><strong>Results:</strong> Our study included 13 patients with LRs (8 men, 5 women): 6 had ENL and 7 had RR. All patients had had at least one previous course of GCs and 2 previous treatment lines before starting MTX. Overall, 8/13 (61.5%) patients had GR, allowing for GCs-sparing and even GCs withdrawal in 6/11 (54.5%). No severe adverse effects were observed. Relapse after MTX discontinuation was substantial (42%): the median relapse time was 5.5 months (range 3–14) after stopping treatment.</p>

<p><strong>Conclusion:</strong> MTX seems to be an effective alternative treatment in LRs, allowing for GCs-sparing with a good safety profile. Furthermore, early introduction during LRs may lead to a better therapeutic response. However, its efficacy seems to suggest prolonged therapy to prevent recurrence.</p>

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