BMJ  2004;328 (19 June), doi:10.1136/bmj.328.7454.0

Steroids do not prevent long term nerve damage in leprosy

Giving prednisolone to patients with leprosy does not prevent long term nerve damage. Smith and colleagues (p 1459) randomised 635 people with newly diagnosed multibacillary leprosy from Bangladesh and Nepal to prophylaxis with low dose prednisolone (20 mg/day for three months) or placebo, in addition to standard multidrug treatment. They found that prednisolone can prevent reaction and impairment of nerve function at four months, but only in people without pre-existing nerve damage, and the effect was not sustained at one year. Routine use of prophylactic steroids in all patients with multibacillary leprosy is not justified, say Lockwood and Kumar (p 1447) in an accompanying editorial.

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