Several previous Congress workshops have discussed the difficulty in distinguishing between a late reaction and relapse in nerve. This remains a clinical and pathologic challenge.
In its consideration of current treatment of reactions, the group expressed concern that there is an absence of data from controlled clinical trials relating to doses of corticosteroids and duration of treatment. There was also concern that the doses and duration of treatment recommended by the WHO 7th Expert Committee [Geneva, June 1997] are too low and too short.
Multicenter trials are currently in progress in India to determine the optional length of treatment with corticosteroids. A randomized control trial of prophylactic corticosteroids to prevent reactions and nerve damage in new MB patients is being done in Bangladesh and Nepal.
The workshop discussed the need to evaluate currently available immunosuppressants as second-line treatment for patients who do not respond to corticosteroids. Multicenter trials are also needed to define the role of neurolysis in the management of acute neuritis. Jul of the above mentioned multicenter trials are required in order to generate high quality evidence for the best treatment of leprosy patients. Funding such trials should be a high priority.
Conclusion
The workshop participants expressed confidence that this combination of careful and appropriate patient evaluation, studies on pathogenesis, and high quality clinical trials will lead to improved care for leprosy patients.
Participants：
D. Lockwood, Chair; D. Scollard, Rapporteur, W Britton, R. Jerskey, R. Barnetson, B. Naafs, Dr Antia, A. Anderson, S. Suneeta, P Saunderson, Dr Shetty, E. Sarno, E. Sampaio
D. Lockwood, London School of Hygiene & Tropcial Medicine, London, U.K.
