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Effective Treatment of Erythema Nodosum Leprosum with Thalidomide Is Associated with Immune Stimulation
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Effective Treatment of Erythema Nodosum Leprosum with Thalidomide Is Associated with Immune Stimulation
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Journal Article
Effective Treatment of Erythema Nodosum Leprosum with Thalidomide Is Associated with Immune Stimulation
2005
Overview
The immunomodulatory drug thalidomide is the treatment of choice for erythema nodosum leprosum (ENL), an inflammatory cutaneous and systemic complication of multibacillary leprosy. To elucidate the mechanism of action of thalidomide in this syndrome, we prospectively investigated 20 patients with ENL who were treated with thalidomide for 21 days. All patients responded to treatment, with the majority of them having complete resolution of cutaneous lesions within 7 days. This response was associated with a marked but transient increase in ex vivo mitogen-induced expression of interleukin (IL)–2 and interferon-γ by CD4+ and CD8+ T cells that was observed on treatment day 7, but these returned to pretreatment levels by day 21. Plasma tumor necrosis factor–α levels were not high at baseline, and they increased modestly during treatment. Plasma levels of IL-12 increased steadily during thalidomide treatment. Hence, the therapeutic effect of thalidomide in ENL appears to be associated with transient immune stimulation, which suggests that the drug may promote an active immunoregulatory response
Publisher
The University of Chicago Press,University of Chicago Press,Oxford University Press
Subject
/ Adult
/ Bacteria
/ Biological and medical sciences
/ CD4-Positive T-Lymphocytes - immunology
/ CD8-Positive T-Lymphocytes - immunology
/ Erythema Nodosum - drug therapy
/ Erythema Nodosum - immunology
/ Erythema Nodosum - pathology
/ Fundamental and applied biological sciences. Psychology
/ Humans
/ Immunologic Factors - pharmacology
/ Immunologic Factors - therapeutic use
/ Interferon-gamma - biosynthesis
/ Leprostatic Agents - pharmacology
/ Leprostatic Agents - therapeutic use
/ Leprosy
/ Leprosy, Lepromatous - drug therapy
/ Leprosy, Lepromatous - immunology
/ Leprosy, Lepromatous - pathology
/ Lesions
/ Male
/ Reverse Transcriptase Polymerase Chain Reaction
/ Skin
