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Year : 2023  |  Volume : 9  |  Issue : 1  |  Page : 13-20

Evaluating the efficacy of apremilast combined with low-dose steroids versus combination of apremilast with low-dose steroids and low-dose aspirin for selected cases in the management of erythema nodusum leprosum: A pilot study

Department of Dermatology, Katihar Medical College, Katihar, Bihar, India

Correspondence Address:
Aditya Kumar Bubna
Department of Dermatology, Katihar Medical College, Karim Bagh, Katihar 854106, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdd.ijdd_47_21

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Background: Erythema nodosum leprosum (ENL) is a reactional state observed in the lepromatous spectrum of leprosy. Currently, systemic steroids and thalidomide constitute the backbone of ENL therapy. Aim: The aim of this study was to evaluate the efficacy of apremilast as a standalone steroid-sparing drug for ENL and its combination with aspirin for selected cases. Materials and Methods: This was a pilot study on 10 patients having recrudescence of ENL following reduction of prednisolone dose to 20mg. Apremilast (30 mg twice daily) was administered to these patients as prednisolone was gradually tapered. The severity of ENL was evaluated based on the 16-item ENLIST ENL Severity Scale (EESS). If the EESS score reduced to zero with 20 mg of prednisolone following apremilast addition, patients were considered apremilast responsive. In case the EESS score reduced by> 50% then low-dose aspirin was added to the therapeutic regimen with gradual taper of steroids, and patients were accordingly evaluated. Those patients not responding to apremilast were labeled non-responders and were switched to thalidomide after appropriate investigations. Results: Out of 10 patients, 1 demonstrated complete clinical response with apremilast. In 5 patients the EESS score with apremilast had reduced by 50% or more; and following the addition of low-dose aspirin complete clinical cure was obtained. The remaining 4 patients were apremilast unresponsive. Conclusion: Apremilast may not be an effective standalone steroid-sparing drug for ENL in all patients. EESS scoring is a valuable tool in assessing treatment responses in all patients with ENL. Low-dose aspirin shows efficacy in those ENL patients demonstrating partial response to apremilast.

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