Tuesday, October 24, 2017

(LML) MDTU and the risk of emergence of resistant strains

 



Leprosy Mailing List – October 24,  2017

Ref.:   (LML) MDTU and the risk of emergence of resistant strains

From:  Jaison Barreto, Bauru, Brazil


 

Dear Pieter

 

I would like to express my fear about the future of the leprosy treatment with MDT WHO. Recently, a paper was published about the effectiveness of 6 doses of MDT for all leprosy patients in some areas of Brazil. Unfortunately, the authors probably did not read any of the classical papers made in the last century.

 

-       Ganapati (1992) compared the MDT 12 and 24 doses with a follow up of 1 to 5 year and did not find any difference in the effectiveness.

-       Ji (1996) advocated the effectiveness of 3 to 6 months of MDT, but 5 years later (2001) published that patients with trillions of M.leprae (LL patients) who abandoned treatment had best results after 10 doses (less relapses).

-       Jamet (1995) reported 7 relapses among 35 patients with high BI thet were treated with MDT 24 doses; the mean time interval for the occurence of relapses was 6 years.

-       Girdhar (2000) found almost the same results among 561 patients, and showed that the more longer follow up, more relapses happened.

 

The time interval for a the appearance of single tuberculoid lesion is 3 to 5 years. The time interval for parasitism restricted to Schwann cell in a LL patient is 10 years. What about 1 to 5 years of follow up? The mean time of relapses of MDT 12 doses is 7 to 10 years in our service. For those treated with 24 doses, this time is 13 to 15 years.Avelleira (2003) evaluated 10 LL patients after 12 doses, and found that 3 patients had viable M. leprae in mouse foot pad assays.

 

What are five years of follow up for M. leprae?

I have seen many cases of relapses among LL patients treated with 12 doses.

In my PhD thesis, I found 4 relapses among 46 LL patients after 11 years of discharge treated with 24 doses in a non endemic area of Brazil, and 23% still had positive serology or PCR in nasal mucus.

 

I hope that leprologists do not accept experiments with leprosy patients without strong scientific basis, i.e., chronic diseases wrongly treated because the follow up was not long enough.

 

Best regards,

 

 

Jaison


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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