Methotrexate and Prednisolone Study in Erythema Nodosum Leprosum

Last updated: March 10, 2025
Sponsor: London School of Hygiene and Tropical Medicine
Overall Status: Active - Recruiting

Phase

N/A

Condition

Hives (Urticaria)

Warts

Skin Wounds

Treatment

Placebo

Methotrexate

Prednisolone

Clinical Study ID

NCT03775460
15762
  • Ages 18-60
  • All Genders

Study Summary

Erythema Nodosum Leprosum (ENL) is a painful, debilitating complication of leprosy. Patients often require high doses of corticosteroids for prolonged periods. Thalidomide is expensive and not available in most countries. The use of corticosteroids for long periods is associated with adverse effects and mortality. It is a priority to identify alternative agents to treat ENL. Methotrexate (MTX) is a cheap, widely used medication which has been reported to be effective in ENL resistant to steroids and thalidomide.

Eligibility Criteria

Inclusion

Inclusion Criteria:: ALL OF THE FOLLOWING SIX CRITERIA MUST BE MET IN ORDER FOR AN INDIVIDUAL TO BE ELIGIBLE (ONLY ONE OF 6A TO 6D NEED BE MET):

  1. Individuals who diagnosed with leprosy complicated by ENL

  2. Individuals with ENL aged 18-60 years old

  3. Individuals with ENL deteriorating symptoms

  4. Individuals with 10 or more tender, papular or nodular ENL skin lesions

  5. Individuals with an EESS score of at least 9

  6. Individuals with ENL on:

  7. No current anti- ENL treatment

  8. Prednisolone up to 30mg per day (if ACUTE) or Prednisolone 10-30mg (inclusive)per day (if RECURRENT/ CHRONIC) or equivalent alternative corticosteroid doseOR

  9. Thalidomide or other non-steroidal anti-ENL medication OR

  10. A combination of prednisolone (up to 30mg) and another non-steroidal anti-ENLmedication (thalidomide, clofazimine, azathioprine, pentoxifylline,ciclosporin, minocycline)

Exclusion

Exclusion criteria:

  1. Individuals who were first diagnosed with ENL more than 4 years prior to enrolment

  2. Individuals less than 18 years old or older than 60 years

  3. Individuals weighing less than 35kg

  4. Individuals with 9 or fewer tender, popular or nodular ENL skin lesions

  5. Individuals with an EESS score of 8 or less

  6. Women of child bearing capacity who decline to use two forms of adequatecontraception and men who decline to use two forms of adequate contraception

  7. Pregnant or breastfeeding women

  8. Individuals with recurrent or chronic ENL who deteriorate on a dose of prednisoloneless than 10 mg or more than 30 mg

  9. Individuals who have taken methotrexate by any route for the last 12 weeks

  10. Individuals with a hypersensitivity to methotrexate or a recognised contraindication ( please see Methotrexate information sheet)

  11. Individuals currently diagnosed with Type 1 reaction or Lucio's phenomenon

  12. Individuals with the severe abnormalities in screening investigations

  13. Positive serology for HIV, Hepatitis B or C

  14. Evidence of tuberculosis or pulmonary fibrosis

  15. A history of chronic liver disease or excessive alcohol or illicit substanceconsumption

  16. Individuals with severe inter-current infections, uncontrolled diabetes, activepeptic ulcer disease, untreated malignancy

  17. Individuals unable to attend regularly for assessment or monitoring

Study Design

Total Participants: 550
Treatment Group(s): 3
Primary Treatment: Placebo
Phase:
Study Start date:
January 15, 2023
Estimated Completion Date:
October 01, 2025

Study Description

This is a double blind randomized controlled trial (RCT) to test the efficacy of MTX for managing ENL. Patients diagnosed with moderate or severe ENL at ENLIST Group centres in Bangladesh, Brazil, Ethiopia, India, Indonesia and Nepal will be randomly allocated to receive a 15 or 20 mg of oral MTX each week for 48 weeks and prednisolone 40 mg per day reducing to zero over 20 weeks. The control group will receive an identical prednisolone scheme. The participants will be stratified into two groups, those with acute ENL, those with chronic/recurrent ENL. The interventions for both populations are the same, although analysed separately. Adverse effects (AE) will be closely monitored clinically and using laboratory tests. Participants will receive folic acid, 5mg daily for 52 weeks except on the day of MTX to prevent AEs, and nausea will be managed with ondansetron.

Connect with a study center

  • TMLI Bangladesh/ DBLM hospital

    Dhaka,
    Bangladesh

    Site Not Available

  • FIOCRUZ

    Rio De Janeiro,
    Brazil

    Site Not Available

  • ALERT

    Addis Ababa,
    Ethiopia

    Site Not Available

  • The Leprosy Mission Trust

    Delhi,
    India

    Active - Recruiting

  • Bombay Leprosy Project

    Mumbai,
    India

    Active - Recruiting

  • Soetomo Hospital

    Surabaya,
    Indonesia

    Site Not Available

  • Anandaban Hospital

    Kathmandu,
    Nepal

    Site Not Available

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