A systematic review of adverse effects associated with systemic corticosteroids in the management of leprosy

by Andie I. Lun, Barbara de Barros, Stephen L. Walker

Background

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis (M. lepromatosis), primarily affecting the skin and peripheral nervous system. Leprosy is complicated by immune-mediated reactions which are risk factors for nerve damage and disability. Systemic corticosteroids are the mainstay of therapy; however, prolonged use in chronic or recurrent reactions carries significant risks but the evidence on the short- and long-term adverse effects of corticosteroids in leprosy is limited. We conducted a systematic review to evaluate corticosteroid-associated adverse effects in leprosy affected individuals.

Methodology

Eight electronic databases were searched (including PubMed, Embase and LILACS) without language or year restriction for studies reporting adverse effects associated with systemic corticosteroid use in individuals with leprosy. Eligible studies included randomised controlled trials, observational studies, case series and case reports. Data variability was assessed using Stata software.

Main findings

A total of 111 studies were included; of which 22 were randomised controlled trials. Due to heterogeneity, findings were synthesised narratively. The most frequently reported adverse effects were metabolic complications, with approximately one-third of individuals developing corticosteroid-induced lipodystrophy. Infections were the second most common adverse effect (15.5%), followed by gastritis (12.6%). Infections accounted for three-quarters of corticosteroid-associated mortality, predominantly due to tuberculosis, with 88.2% of corticosteroid-associated mortalities occurring in individuals with erythema nodosum leprosum (ENL). There was an association between ENL and the development of cataract and osteoporosis, with 69.7% of cataract cases and 84.4% of osteoporosis cases occurring among individuals with ENL.

Conclusion

This systematic review illustrates the range and severity of adverse effects affecting individuals with leprosy who received systemic corticosteroids. Although this review is limited by study heterogeneity, publication bias, and the scarcity of long-term data, it highlights the need for corticosteroid stewardship, structured pharmacovigilance and further research for safer therapeutic alternatives to corticosteroids for leprosy reactions.