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Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial
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  • Published on:
    Methotrexate in erythema nodosum leprosum (MaPs in ENL)
    • Tarun Narang, Dermatologist Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education & Research; Chandigarh, India
    • Other Contributors:
      • Hitaishi Mehta, Dermatologist
      • Sunil Dogra, Dermatologist
      • Bhushan Kumar, Dermatologist

    We read with interest the MaPs in ENL study protocol (de Barros et al, BMJ open 2020).[1] The availability of an alternative drug for cases of chronic or recurrent type 2 lepra reaction with steroid toxicity or unresponsiveness is the need of the hour and although drugs like thalidomide, cyclosporine etc. are prescribed in such patients but cost, adverse effect or non-availability are the major deterrents in their use. The researchers must be complimented for their bold decision to choose methotrexate based only on case reports or a short series of patients (15 patients in total were given methotrexate for type 2 reactions).[2] This is a well-designed protocol aimed at possibly adding another drug to our therapeutic armamentarium for the crippling erythema nodosum leprosum (ENL) reactions. If found useful, methotrexate has the advantage of being a cheap, easy to administer and readily available drug.

    The study proposes to randomize patients with acute, chronic or recurrent ENL into two groups, receiving 20 weeks of prednisolone with either 48 weeks of methotrexate or placebo. While use of methotrexate is justified in patients with chronic and recurrent ENL, , same might not be applicable to cases of acute ENL. Acute ENL, by definition, is an episode that lasts lesser than 24 weeks,[3] as has been defined in the study protocol as well. Most of these cases with acute episode respond well to corticosteroids, clinical response has been observed as early as in 2 week...

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    Conflict of Interest:
    None declared.