Biologics in Leprosy: A Systematic Review and Case Report

• Published in: The American journal of tropical medicine and hygiene 2020-05, Vol.102 (5), p.1131-1136
• Main Authors: Cogen, Anna L, Lebas, Eglantine, De Barros, Barbara, Harnisch, James P, Faber, William R, Lockwood, Diana N, Walker, Stephen L
• Format: Article
• Language: English
• Subjects: Adult; Biological products; Biological Products - therapeutic use; Case reports; Humans; Infliximab - therapeutic use; Leprostatic Agents - therapeutic use; Leprosy; Leprosy - drug therapy; Male; Monoclonal antibodies; Systematic review; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.19-0616

Tumor necrosis factor (TNF)-α inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-α inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-α inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNF-α inhibitors. Finally, TNF-α inhibitors appear effective in some cases of refractory ENL.