Mendes Ana Flávia Moura, Gomes Ciro Martins, Kurizky Patrícia Shu, Ianhez Mayra
Dermatologia, Hospital de Doenças Tropicais, Goiânia, Brazil.
Departamento de Dermatologia, Universidade de Brasília (UnB), Brasília, Brazil.
Front Med (Lausanne). 2022 Jun 24;9:879527. doi: 10.3389/fmed.2022.879527. eCollection 2022.
Patients with leprosy may experience a chronic and severe type II leprosy reaction (ENL) erythema nodosum leprosum that may not respond to thalidomide and systemic immunosuppressants or may even cause serious adverse events. We here present four patients in whom anti-TNF-α therapy was used with successful results and compare our findings with other published cases. Four patients with chronic and severe ENL who did not respond to, at least, thalidomide and steroids (high doses) were followed up at two reference centers in Brazil. A thorough laboratory investigation was performed to exclude tuberculosis and other diseases before the start of immunobiological medication. Three patients were started on etanercept, and one patient was started on adalimumab. Of all patients, three developed severe adverse events resulting from the use of classical immunosuppressants for ENL (cataracts, deep vein thrombosis, diabetes, and osteoporosis). In all cases, a reduction in the number of ENL and, at least half of the immunosuppressant dose between 6 months and 2 years, were observed. Long-term follow-up of one patient revealed a dramatic reduction in hospital admissions due to ENL, from 12 instances in 1 year (before biologic therapy) to none (after biologic therapy), along with an improvement in condyloma acuminatum. In addition, no direct adverse events were observed with biologics. Treatment with anti-TNF-α therapy may be used as an alternative in patients with chronic and severe ENL who do not respond to traditional treatment (e.g., thalidomide, steroids, and other immunosuppressants). This treatment can help reduce the frequency of ENL, the immunosuppressive burden, and the number of hospital admissions.
麻风病患者可能会经历慢性且严重的II型麻风反应（ENL），即结节性红斑麻风，这种反应可能对沙利度胺和全身性免疫抑制剂无反应，甚至可能导致严重不良事件。我们在此介绍4例使用抗TNF-α疗法取得成功的患者，并将我们的研究结果与其他已发表的病例进行比较。4例患有慢性严重ENL且至少对沙利度胺和类固醇（高剂量）无反应的患者在巴西的两个参考中心接受随访。在开始免疫生物药物治疗前，进行了全面的实验室检查以排除结核病和其他疾病。3例患者开始使用依那西普，1例患者开始使用阿达木单抗。所有患者中，3例因使用经典的ENL免疫抑制剂出现了严重不良事件（白内障、深静脉血栓形成、糖尿病和骨质疏松症）。在所有病例中，均观察到ENL数量减少，且在6个月至2年期间免疫抑制剂剂量至少减少了一半。对1例患者的长期随访显示，因ENL导致的住院次数大幅减少，从生物治疗前1年的12次降至生物治疗后的0次，同时尖锐湿疣有所改善。此外，未观察到生物制剂直接导致的不良事件。对于对传统治疗（如沙利度胺、类固醇和其他免疫抑制剂）无反应的慢性严重ENL患者，抗TNF-α疗法可作为一种替代治疗方法。这种治疗有助于减少ENL的发作频率、免疫抑制负担以及住院次数。
