Azathioprine as a Steroid Sparing Agent in Recalcitrant Type 2 Reaction

Introduction Severe recalcitrant Type 2 Leprosy reaction (ENL) is recalcitrant to conventional therapy & characterized by ulcerative necrotic skin lesions, known as Erythema Nodosum Necroticans and required long term systemic glucocorticoid therapy which leads to serious complications. To prevent serious side effects of ENL one should consider steroid sparing agents. Azathioprine is generally well tolerated and has a favourable therapeutic index compared with other traditional immunosuppressant. In our study, severe ENL patients recalcitrant to conventional therapy were successfully managed with Azathioprine monotherapy. Objective - To evaluate Azathioprine as a steroid sparing agent. - To prevent serious side effects of Glucocorticoids. - To prevent systemic complications of severe Type 2 leprosy reaction. Methods Total 14 cases of severe recalcitrant T2R were enrolled in study. We started Azathioprine average 100 mg per day in all 14 patients for total period of 12 months along with oral Prednisolone and anti leprosy treatment (MB Adult Pack). Clinical & laboratory evaluations were done at baseline (0), 3, 6, 9 & 12th month. Results At the end of 12 months, only one patient showed recurrence of ENL & remaining 13 patients (92.85 %) were absolutely fine & they didn-t require any immunosuppressive. We found serious side effects of Glucocorticoids before treatment which were prevented at the completion of study, as early as at 6 months & serious necrotic skin lesions before treatment were healed with Azathioprine & Prednisolone combination. In our study we found 92.85 % success rate in Azathioprine treatment in severe recalcitrant T2R. Conclusion Azathioprine is a good adjuvant immunosuppressive drug in the control of recalcitrant Type 2 reactions, and especially as a GCS sparing agent with minimum side effects.