Email updates

Keep up to date with the latest news and content from BMC Neurology and BioMed Central.

Open Access Study protocol

Two randomized controlled clinical trials to study the effectiveness of prednisolone treatment in preventing and restoring clinical nerve function loss in leprosy: the TENLEP study protocols

Inge Wagenaar1*, Wim Brandsma2, Erik Post3, Wim van Brakel3, Diana Lockwood4, Peter Nicholls5, Paul Saunderson6, Cairns Smith7, Einar Wilder-Smith8 and Jan Hendrik Richardus1

Author Affiliations

1 Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

2 Independent Leprosy Consultant, Amsterdam, The Netherlands

3 Royal Tropical Institute, Development Policy & Practice, Amsterdam, the Netherlands

4 Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

5 Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom

6 American Leprosy Missions, Greenville, SC, USA

7 Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK

8 Department of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

For all author emails, please log on.

BMC Neurology 2012, 12:159  doi:10.1186/1471-2377-12-159

Published: 18 December 2012

Abstract

Background

Nerve damage in leprosy often causes disabilities and deformities. Prednisolone is used to treat nerve function impairment (NFI). However, optimal dose and duration of prednisolone treatment has not been established yet. Besides treating existing NFI it would be desirable to prevent NFI. Studies show that before NFI is clinically detectable, nerves often show subclinical damage. Within the ‘Treatment of Early Neuropathy in LEProsy’ (TENLEP) study two double blind randomized controlled trials (RCT) will be carried out: a trial to establish whether prednisolone treatment of 32 weeks duration is more effective than 20 weeks in restoring nerve function in leprosy patients with clinical NFI (Clinical trial) and a trial to determine whether prednisolone treatment of early sub-clinical NFI can prevent clinical NFI (Subclinical trial).

Methods

Two RCTs with a follow up of 18 months will be conducted in six centers in Asia. In the Clinical trial leprosy patients with recent (< 6 months) clinical NFI, as determined by Monofilament Test and Voluntary Muscle Test, are included. The primary outcomes are the proportion of patients with restored or improved nerve function. In the Subclinical trial leprosy patients with subclinical neuropathy, as determined by Nerve Conduction Studies (NCS) and/or Warm Detection Threshold (WDT), and without any clinical signs of NFI are randomly allocated to a placebo group or treatment group receiving 20 weeks prednisolone. The primary outcome is the proportion of patients developing clinical NFI. Reliability and normative studies are carried out before the start of the trial.

Discussion

This study is the first RCT testing a prednisolone regimen with a duration longer than 24 weeks. Also it is the first RCT assessing the effect of prednisolone in the prevention of clinical NFI in patients with established subclinical neuropathy. The TENLEP study will add to the current understanding of neuropathy due to leprosy and provide insight in the effectiveness of prednisolone on the prevention and recovery of NFI in leprosy patients. In this paper we present the research protocols for both Clinical and Subclinical trials and discuss the possible findings and implications.

Trial registration

Netherlands Trial Register: NTR2300

Clinical Trial Registry India: CTRI/2011/09/002022

Keywords:
Leprosy; Prednisolone; Nerve function impairment; Subclinical neuropathy