You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Double-Blind Controlled Clinical Trial of Clofazimine in Reactive Phases of Leprotamous Leprosy*
Abstract 1:
A double-blind controlled trial in 24 lepromatous leprosy patients in reaction showed that clofazimine ( Lamprene ) controlled symptoms of erythema nodosum leprosum reaction in lepromatous leprosy better than prednisolone . Clofazimine also appeared to be significantly superior in preventing recurrence once the reaction had been controlled . There was a statistically significant rise in serum albumin among in patients on clofazimine as compared with patients on prednisolone , but no difference in terms of neurological status , bacterial index , morphological index , and renal functions . Red/black hyperpigmentation was seen among practically all patients on clofazimine . No other side-effects or deleterious systemic effects were observed


Title 2:
Double-blind trial of the efficacy of pentoxifylline vs thalidomide for the treatment of type II reaction in leprosy.
Abstract 2:
Type II reaction in leprosy , or erythema nodosum leprosum ( ENL ) , is often characterized by severe clinical symptoms together with nerve function impairment leading to permanent disabilities . Thalidomide has been shown to be a highly effective drug for the treatment of ENL . It is , however , contraindicated for women of childbearing age due to its teratogenicity . On the other h and , pentoxifylline , used to treat hypercoagulable states , is not teratogenic and , like thalidomide , can inhibit the synthesis of tumor necrosis factor-a and other cytokines . In the present r and omized double-blind clinical study we compared the effectiveness of orally administered pentoxifylline vs thalidomide in treating type II reaction in 44 patients . Daily doses of 300 mg thalidomide or 1.2 g pentoxifylline were administered for 30 days to multibacillary leprosy patients undergoing type II reaction . R and omly chosen patients were included in the study before , during , and after specific  multidrug therapy .  Clinical evaluations were performed on the 1st , 7th , 14th , 21st , and 30th days of treatment and laboratory tests were carried out on the 1st and 30th days . As expected , overall , thalidomide proved to be more effective in the treatment of type II leprosy reaction . Nevertheless , continuous treatment with pentoxifylline was effective in relieving the clinical signs of ENL , especially limb edema and systemic symptoms , in 62.5 % of the patients


Title 3:
Pulsed corticosteroid therapy in patients with chronic recurrent ENL: a pilot study.
Abstract 3:
A pilot study has been undertaken to compare the efficacy of small dose pulsed betamethasone therapy with need based oral steroids in chronic recurrent erythema nodosum leprosum ( ENL ) patients . Though this mode of therapy was well tolerated , no advantage with intermittent steroid administration was observed . This could have been on account of small dose of steroid given monthly . Treatment of chronic recurrent erythema nodosum leprosum ( ENL ) patients continues to be unsatisfactory , particularly , because of nonavailability of thalidomide . Though corticosteroids are effective in suppressing all the manifestations and even restoring partially or fully the functional impairment , their side effects and dependence are equally troublesome . Based on ( a ) the reported efficacy and safety of intermittent use of corticosteroids in several immune complex mediated disorders ( Cathcart et al 1976 , Kimberly et al 1979 ) , Liebling et al 1981 and Pasricha & Gupta 1984 ) and ( b ) ENL ( type II ) reactions having similar pathology , a pilot study has been undertaken to see the efficacy and the tolerance of pulsed steroids in chronic ENL patients


Title 4:
A randomized, double-blind, double-dummy, controlled dose comparison of thalidomide for treatment of erythema nodosum leprosum.
Abstract 4:
In a r and omized , double-blind , double-dummy controlled study , 22 men with erythema nodosum leprosum ( ENL ) received six capsules containing either 100 mg ( group A , n = 12 ) or 300 mg ( group B , n = 10 ) of thalidomide daily for one week . A six-week , four capsules per day taper followed , in which group A received 50 mg/day of thalidomide in weeks 2 and 3 , then dummy capsules in weeks 4 through 7 , while group B had gradual decrements every two weeks . Both regimens caused comparable improvement in 19 patients at day 7 ( group A [ 12 of 12 ] versus group B [ 7 of 10 ] ; P = 0.08 ) , but slower tapering in group B showed less re-emergence of ENL through week 7 ( P = 0.02 , versus group A ) . Most patients developed new lesions soon after stopping treatment . Slower tapering from a higher initial thalidomide dose may improve clinical ENL responses , but high recurrence rates after discontinuation indicates further assessment is needed to identify better tapering regimens


Title 5:
WHO co-ordinated short-term double-blind trial with thalidomide in the treatment of acute lepra reactions in male lepromatous patients.
Abstract 5:
The treatment of lepra reactions constitutes one of the most serious problems in leprosy . For this reason , the first reports in 1965 of the favourable results obtained with thalidomide aroused considerable interest and led WHO , in 1967 , to carry out a trial with the co-operation of four centres . A short-term double-blind trial was design ed to study the effect of thalidomide , in comparison with acetylsalicylic acid , in the treatment of acute lepra reactions in male lepromatous patients .  Acetylsalicylic acid was used instead of a placebo because of its antipyretic and analgesic activity . Because of the severe adverse reactions that may be caused by thalidomide , mainly the teratogenic effects , only males were included in the trial . The results of this short-term study seem to confirm previous reports of the efficacy of thalidomide  and indicate that acetylsalicylic acid also seems to be helpful in the management of certain symptoms of lepra reactions


Title 6:
Results of a double blind study of the influence of thalidomide on the lepra reaction.
Abstract 6:
The first thalidomide experiments in this series ( I . ~ . : l ) were aim ed at evaluating the effectiveness of this drug in relation to a placebo , and were carried out on a small number of patients . The present double blind study extends the observations to a larger group of patients and exp and s the observa tional criteria . In a prelimina . y report ( I ) data were presented on the procedure and results of the experiment which was carried out in Caracas in 1963 - 1966 . The present paper presents the results of clinical and laboratory tests , notes side effects in detail , and in cludes a statistical evaluation
There is some evidence of benefit for thalidomide and clofazimine , but generally we did not find clear benefits for interventions in the management of ENL .