Dr. Debdeep Mitra

Command Hospital Air Force Bangalore, India

Title: Management of Leprosy Patients with New Type 1 Lepra Reaction



The type of leprosy that affects an individual depends on the immune response mounted against the organism. This leads to a spectrum of disease which may be complicated by immunological phenomena called reactions. Antimicrobial chemotherapy is effective in treating the Mycobacterium leprae infection but up to 30% of individuals with borderline disease experience Type 1 reactions(T1Rs). T1Rs are immunologically mediated episodes, localised in skin and nerves, which are a major cause of nerve function impairment. Nerve function impairment may result in disability and deformity.

Leprosy Type 1(T1Rs) reactions are immune-mediated events leading to nerve damage and preventable disability affecting hands, feet and eyes which are treated with corticosteroids. There is little evidence on alternative treatments for patients who don’t respond to steroids or experience steroid adverse effects. We report the results of a randomized controlled trial testing the efficacy and adverse effect profile of Adalimumab and Prednisolone(A+P) in comparison to Prednisolone only (P) in patients with new T1R in a tertiary hospital. Adalimumab is a TNF-Alpha blocker and the levels of TNF-Alpha were correlated before and after the clinical intervention.

Systemic corticosteroids are the mainstay of treatment of T1Rs although conclusive evidence of their efficacy is lacking. The optimal dose and duration of treatment with steroids is still unclear although there is evidence that suggests prolonged therapy improves outcome.

This is the first double-blind Randomized controlled trial assessing Adalimumab, in management of T1R. Adalimumab could be a safe alternative second-line drug for patients with T1R who are not improving with prednisolone or are experiencing adverse events related to prednisolone. This study illustrates the difficulty in switching off leprosy inflammation. This is a first study highlighting the safe use of a Biologic drug in a chronic granulomatous infectious disease.


Dr. Debdeep Mitra presently working as Professor at Dept. of Dermatology, Command Hospital Air Force, Bangalore, India. Earlier he worked as Associate Professor at Base Hospital Delhi Cantt, New Delhi. He received doctoral degree in the year 2013 from the Armed Forces Medical College, Pune, India. His research prime objective is to manage patients with an infectious disease, leprosy which is considered a social stigma. To his credit, he has published more than 50 articles in various international peer reviewed journals and presented at more than 80 national and international forums.

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