title: Multi-centre, double blind, randomized trial of three steroid regimens in the treatment of type-1 reactions in leprosy.
abstract: OBJECTIVE
  The objective of this randomized trial was to compare three different steroid regimens in treating type 1 reactions in leprosy in routine clinical practice.
  
  
  METHODS
  The study design was a multicentre, double-blind, randomized, controlled, parallel group trial in patients with acute reversal reactions. The trial was conducted in six leprosy treatment centres in India. A total of 334 participants with acute type 1 reaction were recruited to the trial and randomized to one of three prednisolone regimens: high dose (60 mg per day) or low dose (30 mg per day) both tapered over 20 weeks, and short duration (60 mg per day tapered over 12 weeks). The main outcome measure was the proportion of patients failing to respond to treatment and requiring additional steroids.
  
  
  RESULTS
  At the end of 12 months, 46% on the short course required additional steroids compared with 31% on the low dose and 24% on the high dose regimen.
  
  
  CONCLUSIONS
  The two 20-week regimens were significantly better than the 12-week regimen. The high dose 20-week regimen was marginally and non-significantly better than the low dose regimen, but the high dose regimen contained 50% more steroid. Reactions in leprosy persist over many months and require long courses of steroids.
authors.affiliation: Schieffelin Leprosy Research and Training Centre, Karigiri, Tamil Nadu 632106, India.
authors.forename: P S S Sundar
authors.initials: PS
authors.lastname: Rao
authors.forename: D S T
authors.initials: DS
authors.lastname: Sugamaran
authors.forename: J
authors.initials: J
authors.lastname: Richard
authors.forename: W C S
authors.initials: WC
authors.lastname: Smith
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007194:India; D007917:Leprostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007918:Leprosy / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007917:Leprostatic Agents; D011239:Prednisolone