Prevention of peripheral nerve damage in leprosy

Sir,
Peripheral nerve damage is the most important problem in leprosy, leading to the disabilities we
are so familiar with. Apart from treatment with corticosteroids during the active phase of neuritis,
very little can be done once peripheral nerves are damaged. The only hopeful development at
present is a microsurgical technique of nerve decompression pioneered by Dr W J Theuvenet at
Anandaban Leprosy Hospital in Nepal.
I would like to draw attention to the potential possibility of a medical approach. Recently an
article appeared in the New England Journal of Medicine describing the positive results of an ACTH
(4-9) analogue, Org 2766, in the prevention of cisplatin induced neuropathy in patients treated for
ovarian cancer. Although the exact mechanism is not known, evidence suggests that the presence of
melanocortins (such as Org 2766) in nerve tissue may trigger off or facilitate neural repair.
Melanocortins have already proved beneficial in rats with crush injuries, cut injuries, diabetic
neuropathy, acrylamide neuropathy and cisplatin neuropathy. Org 2766 showed no adverse
reactions in humans in the trial described and the authors consider it as promising in the treatment
of other forms of neuropathy as well.
At present there is no experience with Org 2766 at all in neuropathy caused by leprosy. In view
of the potential of this drug, I recommend that full attention is given to it by researchers in the field
of leprosy. Every possibility to prevent or treat nerve damage in leprosy is of paramount
importance