Cyclosporine A treatment of leprosy patients with chronic neuritis is associated with pain control and reduction in antibodies against nerve growth factor.
OBJECTIVE
Chronic neuritis (CN) is still a major problem in leprosy and is difficult to manage in patients who do not respond well to prednisone. In this study we (i) evaluate the efficacy of cyclosporine A (CyA) in controlling CN patients, and (ii) analyse the presence of anti-NGF antibodies in the sera of leprosy patients, and their behaviour during CyA treatment.


METHODS
This was an open, prospective, non-comparative study. Sixty-seven leprosy patients in three different institutions in Pará, Brazil were studied from January, 2001 to January, 2004. Of these, 47 had no CN and 20 were leprosy patients suffering from CN and taking at least 40 mg/day prednisone to control nerve impairment and pain. Patients received 12 months reducing course CyA starting at 5 mg/kg per day. The outcome measure was sensory impairment, assessed using Semmes-Weinstein monofilament examination (SWME), muscular force and spontaneous or palpation-related pain.


RESULTS
Antibodies against NGF were detected in the sera of leprosy patients, which may explain the depletion of NGF in leprosy contributing to neuritis, inflammation and loss of cutaneous nociception. The levels of these antibodies in CN patients were slightly lower than in patients with no CN. However, anti-NGF titres in CN patients treated with CyA were lowered to levels similar to those in the normal subjects. There was also improvement in sensory impairment, muscular force and pain.


CONCLUSIONS
These data suggest that anti-NGF antibodies are present in the sera of leprosy patients and may influence the outcome of neuritis, and that CyA might be a useful drug in controlling nerve impairment and pain in leprosy patients.
Sena
Chubert Bernardo Castro De
CB
Departamento de Fisiologia, Laboratório de Neuroquímica Molecular e Celular, UFPA, Belém, Pará, Brasil.
Salgado
Claudio Guedes
CG
Tavares
Claudia Moacilene Penalber
CM
Da Cruz
Carlos Alberto Vieira
CA
Xavier
Marília Brasil
MB
Do Nascimento
José Luiz Martins
JL
D000818:Animals; D000906:Antibodies / Q000187:drug effects; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007918:Leprosy / Q000150:complications*; D020932:Nerve Growth Factor / Q000276:immunology; D009443:Neuritis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016716:PC12 Cells; D010147:Pain Measurement; D011446:Prospective Studies; D051381:Rats; D012018:Reflex / Q000502:physiology; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000906:Antibodies; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020932:Nerve Growth Factor