Alternative regimens for multi-drug therapy (MDT) in leprosy

Leprosy Mailing List – January, 27^th, 2010

Ref.: Alternative regimens for multi-drug therapy (MDT) in leprosy

From: Diana Lockwood, London, UK

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Dear Salvatore,

In Reply to Dr Gilead's request (LML Jan. 19^th, 2010).

The whole topic of alternative regimens for MDT is given too little attention. I think that the level of adverse effects due to dapsone has been under-recognised and we are starting to see significant rates of adverse effects when we look for them. Patricia Deps (Lepr Rev. 2007 Sep;78(3):216-22.) has reported that 45% of Brazilian patients had adverse effects with leprosy MDT, 43.8% to Dapsone, 12.3% to Rifampicin and 9.2% to Clofazimine. In a study I am currently doing in India we are also seeing significant rates of anaemia in patients on Dapsone.

If a patients cannot tolerate Dapsone or Clofazimine then using single dose monthly Rifampicine, Ofloxacine and Minocicline (ROM) is an option. The study which gives one some confidence in using this is the study by Villarmosa et al (Am J Trop Med Hyg 2004 70(2): 197-200) who compared monthly ROM against MD-MDT in a group of BL and LL patients in the Philippines and they reported a satisfactory fall in the bacterial index (BI) of these patients. We have used this in a patients with LL who has liver failure. After a year on treatment his BI is falling and he has not yet had ENL.

I think that we should be doing larger studies to establish the role of monthly ROM in the anti-bacterial treatment of leprosy in patients with adverse effects or problems with compliance.

Diana

Diana Lockwood
Professor of Tropical Medicine
London School of Hygiene & Tropical Medicine
Keppel St
London WC1E 7HT
diana.lockwood(at)lshtm.ac.uk
Tel: 020 7927 2457
Fax: 020 7637 4314