02323nas a2200421   4500000000100000008004100001260001300042653001500055653001000070653001700080653001300097653001100110653001100121653002900132653001200161653000900173653001600182653001000198653002400208653002200232100001800254700001500272700001400287700001600301700001000317700001600327700001300343700001500356700001700371700001500388700001100403700001600414245010900430300001200539490000800551520132800559022001401887       2007                            d  c2007 Oct10aAdolescent10aAdult10aCyclosporine10aEthiopia10aFemale10aHumans10aImmunosuppressive Agents10aleprosy10aMale10aMiddle Aged10aNepal10aProspective Studies10aTreatment Outcome1 aMarlowe S N S1 aLeekassa R1 aBizuneh E1 aKnuutilla J1 aAle P1 aBhattarai B1 aSigdel H1 aAnderson A1 aNicholls P G1 aJohnston A1 aHolt D1 aLockwood DN00aResponse to ciclosporin treatment in Ethiopian and Nepali patients with severe leprosy Type 1 reactions.  a1004-120 v1013 a<p>Leprosy type 1 reactions (T1R) are immune-mediated events with inflammation of peripheral nerves and skin. We report the clinical outcomes of a closely monitored open prospective trial in which eight Nepali and 33 Ethiopian patients with T1Rs were treated with an Indian generic formulation of ciclosporin (Cn; 5-7.5 mg/kg/day) for 12 weeks and followed up for 24 weeks after starting treatment. Outcomes were measured using a clinical severity score. Among the Nepalis, 75-100% improved in all acute clinical parameters; 67-100% patients maintained improvement, except for those with acute sensory nerve impairment among whom 67% relapsed after stopping treatment. The skin lesions of all Ethiopians on 5 mg/kg/day of Cn improved and 50-60% had peripheral nerve function improvement. Most Ethiopians needed a higher dose of Cn to improve nerve impairment and neuritis, and 50-78% of them developed worse clinical severity scores when Cn was stopped. Four Ethiopians and two Nepalis developed elevated serum creatinine levels on 7.5 mg/kg/day Cn, and three (9%) Ethiopians developed treatable hypertension. This suggests that Cn monotherapy is an effective treatment for severe T1R with few adverse effects. A dose of 5 mg/kg/day seems efficacious in Nepalis, but a higher dose may be required in Ethiopian patients.</p>  a0035-9203