Comparative efficacy of thalidomide and prednisolone in the treatment of moderate to severe erythema nodosum leprosum: a randomized study

Australas J Dermatol. 2009 Aug;50(3):181-5. doi: 10.1111/j.1440-0960.2009.00534.x.


The present study was undertaken to compare the efficacy and safety of thalidomide to that of oral prednisolone in the treatment of moderate to severe type 2 lepra reaction. Sixty patients with a histologically confirmed diagnosis of erythema nodosum leprosum with a clinical score of 4 or more (i.e. moderate to severe type 2 reaction) were randomly allocated to two groups comprising 30 patients each. Group 1 patients were given thalidomide at a dose of 300 mg/day for 1 week and the dose was gradually reduced, and Group 2 received prednisolone 40 mg daily for 2 weeks, which was tapered by 10 mg every 2 weeks. Thalidomide induced a faster clinical response (cutaneous as well as systemic) compared with prednisolone. Patients taking thalidomide had fewer relapses and a longer period of remission than those receiving prednisolone.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Adult
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Erythema Nodosum / diagnosis
  • Erythema Nodosum / drug therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Leprosy, Lepromatous / diagnosis
  • Leprosy, Lepromatous / drug therapy*
  • Male
  • Middle Aged
  • Prednisolone / administration & dosage*
  • Prednisolone / adverse effects
  • Probability
  • Prospective Studies
  • Recurrence
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Thalidomide / administration & dosage*
  • Thalidomide / adverse effects
  • Treatment Outcome


  • Thalidomide
  • Prednisolone