A randomized controlled trial of prednisolone vs TNF-alfa inhibitor Infliximab in the management of type 1 lepra reaction in leprosy patients

Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Type 1 lepra reactions (T1R) are an acute inflammatory response during the chronic course of the disease. It is delayed hypersensitivity (type IV) reaction which if not treated promptly with immune suppression, can lead to permanent disability affecting hands, feet and eyes. Tumour necrosis factor-alpha (TNF-α) is up regulated in patients of type I lepra reaction. Conventionally oral corticosteroids steroids have been the main stay in the management of type 1 lepra reactions. We report the results of this randomized control study wherein an immuno-modulator biologic molecule (Infliximab) has been safely used to treat an inflammatory reaction. Outcomes were measured using recurrence rate, a clinical severity score, quality of life and adverse events.