{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:09:08Z","timestamp":1790834948125,"version":"4.1.0"},"reference-count":28,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,6]]},"abstract":"<jats:p>Tumor necrosis factor (TNF)-\u03b1 inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-\u03b1 inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-\u03b1 inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNF-\u03b1 inhibitors. Finally, TNF-\u03b1 inhibitors appear effective in some cases of refractory ENL.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0616","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T03:00:21Z","timestamp":1583809221000},"page":"1131-1136","source":"Crossref","is-referenced-by-count":36,"title":["Biologics in Leprosy: A Systematic Review and Case Report"],"prefix":"10.4269","volume":"102","author":[{"given":"Anna L.","family":"Cogen","sequence":"first","affiliation":[{"name":"Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eglantine","family":"Lebas","sequence":"additional","affiliation":[{"name":"Department of Dermatopathology, St John\u2019s Institute of Dermatology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"De Barros","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Harnisch","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Faber","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana N.","family":"Lockwood","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L.","family":"Walker","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1016\/S0140-6736(04)15952-7","article-title":"Leprosy","volume":"363","author":"Britton","year":"2004"},{"key":"b2","series-title":"Lepr Rev","doi-asserted-by":"publisher","first-page":"242","DOI":"10.47276\/lr.79.3.242","article-title":"The biology of nerve injury in leprosy","volume":"79","author":"Scollard","year":"2008"},{"key":"b3","series-title":"Int J Lepr Other Mycobact Dis","first-page":"255","article-title":"Classification of leprosy according to immunity. 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