Leprosy Mailing List – November 10, 2015
Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020
From: Sinésio Talhari, Manaus, Brazil
Dear Colleagues,
The concerns of Dr. Rao and Indian dermatologists in relation to the possible modification of the multidrug treatment for an uniform regimen, with duration of 06 months, will be similar in my country, when the Brazilian Dermatologists will be faced with this possibility. But maybe they did not have the adequate information yet.
In Brazil, we are more than 7500 dermatologists and so far many colleagues do not accept the reduction of the multidrug treatment to 12 months and apply the treatment more than necessary, without scientific basis. The same occurred when WHO recommended treatment reduction to 24 months, in the 90´s.
At the beginning of the MDT treatment, with recommendations to the multibacillary patients to be treated until reaching a negative BI and be released, there has also been important reaction against the implementation of this treatment by the dermatological community. I believe that this occurred in most endemic countries.
As a dermatologist expert in leprosy, linked to the leprosy control program in the State of Amazonas (Brazilian Amazon), I followed this whole process, since 1982. We were the first to deploy the MDT treatment.
It was developed in Brazil "An independent clinical trial of uniform multidrug therapy regimen - six doses for all leprosy patients – (U-MDT-CT- BR)". Since its beginning, this study has an independent scientific steering committee composed of expert scientists and clinicians from Brazil and abroad following it. We cannot be authors of the manuscripts to avoid conflict of interest. The experts are Celina Martelli, Diana Lockwood, Euzenir Sarno, Ji BahongV, Maria Leide de Oliveira, Paulo Machado, Sinésio Talhari and V. Pannikar.
The data obtained are robust and, I believe, for the first time, we have a solid foundation to suggest the changing of the therapeutic scheme. Below are papers already published and/or accepted for publication.
At the moment, acting as editor of the Brazilian Annals of Dermatology, we have prepared an editorial for Brazilian dermatologists to have scientific bases for the changes that will surely occur. Unfortunately, over the years, we have fewer and fewer dermatologists who are interested in the serious public health problem that leprosy is in still most of the previously endemic countries.
Finally the WHO is absolutely correct to discuss the possibility of implementing U-MDT for all Leprosy patients without any kind of classification. It will be highly important to implement the leprosy control activities in the primary health care. The "An independent clinical trial of uniform multidrug therapy regimen - six doses for all leprosy patients – (U-MDT-CT- BR)" is a randomized and controlled clinical trial with good follow-up period, with sophisticated epidemiological analysis involving these schemas, and its results are published.
Prof. Dr. Sinésio Talhari
Universidade Nilton Lins
Fundaçao de Dermatologia Tropical e Venereologia "Alfredo da Matta"
Manaus, Am, Brasil
PENNA, G. O., PONTES, M., CRUZ, R., GONÇALVES, H, PENNA, M.L.F; Bührer-Sékula, S - A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design. Mem. Ist. Oswaldo Cruz, 2012, 107 (Suppl. I): 22 – 27. Link POP and CRF GONÇALVES, H.S; PONTES, M.A.A; Bührer-Sékula, S, CRUZ, R; Moraes, M.E.A;
PENNA, G. O. - Brazilian clinical trial of uniform multidrug therapy for leprosy patients - the correlation between clinical disease types and adverse effects. Mem. Inst. Oswaldo Cruz, 2012, 107( Suppl. I):22 – 27 PENNA, M.L.F; Bührer-Sékula, S, PONTES, M.A.A; CRUZ, R;
PENNA, G. O. - Primary results of Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR): reactions frequency in multibacillary patients. Lepr Rev (2012) 83, 308–319
PENNA,M.L.F, Bührer-Sékula, S, PONTES, M.A., CRUZ, R., PENNA, G. O. -Results from the Clinical Trial of Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR): Decrease in Bacteriological Index. Lep. Rev., v.85, p.262 - 266, 2014. FERREIRA, I.P.S.; BUHRER-SEKULA, S; OLIVEIRA, M.R.F; GONÇALVES H.S; PONTES, M.A.A; PENNA, M.L.F; CRUZ, R; &
PENNA, G.O. Patient profile and treatment satisfaction of Brazilian leprosy patients in a clinical trial of uniform six-month multidrug therapy (U-MDT/CT- BR). Lear Rev (2014) 85, 267–274. Moura, R.S;
Penna, G.O; Cardoso, L.P.V.C; Pontes, M.A.A.P.; Cruz, R; Gonçalves, H.S; Penna, M.L.F; Stefani, M.M.A; Bührer-Sékula, S; Description of leprosy classification at baseline among patients enrolled at the uniform multidrug therapy clinical trial for leprosy patients in Brazil – Accept by AJTMIH
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
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