Fw: (LML) Replacing opinions about leprosy treatment with research

 

 

Leprosy Mailing List – November 23,  2020

 

Ref.:  (LML) Replacing opinions about leprosy treatment with research

 

From:  P. Narasimba Rao, Hyderabad, India

 

 

Dear Pieter, 

 

It was  nice reading the recent discussion going on on this topic. 

 

From 1998 onwards  Global leprosy programme. except  for a few countries,  have been following the same drugs and regimen for managing leprosy, which is the curtailed / shortened  version of 1982 WHO recommendation. 

 

Only recently in year 2018, WHO has in  recently in 2018 come out with a document, 'Guidelines for the diagnosis treatment and prevention of leprosy. which suggested  providing  all three drugs (dapsone and clofazimine daily and rifampicin once a month) to both PB and MB leprosy, but for different durations (6 and 12 months). (https://www.who.int/lep/resources/9789290226383/en)  This document states that these guidelines were developed utilizing WHO guideline development methods based on the GRADE1 process, unlike previous WHO  leprosy guidance documents developed through Expert Committee meeting reports and/or through other technical documents.  This indicates that these recommendations are based on higher evidence/ better process.  Nonetheless, this recommendation did not find a place in the proposed Global leprosy strategy 2021-2030 document as a recommendation for implementation.  It will be interesting to know the reasons.

 

And discussing further on  effective  leprosy MDT protocols, while we the  leprosy scientific community  is  busy looking at newer drugs such ofloxacin, minocycline clarithromycin and others, we are completely ignoring a known drug for too long for  its effective chemotherapy  potential, which is Rifampicin in daily dosage format. 

 

The Recommended treatment regimen from the National Hansen's Disease Program  and the United States Health Resources and Services Administration includes use of rifampicin daily for 12 months for PB and 24 months for MB leprosy, along with other two drugs.  And this recommendation is  in force for many years and decades.  And we cannot call them unwise!  Centers for Disease Control (CDC) USA, reports that there are about 150-250 new leprosy cases every year in the US, which means all these patients are  receiving daily rifampicin without any reported issues/ serious adverse reports  as a part of effective MDT.  

 

If it is effective for leprosy  patients seen in the US, (where patients are mostly immigrants/ migrants from other countries such as India/ Brazil/ Bangladesh etc), the same regimen would be effective in other/these countries as well.   

 

It is time the daily use of rifampicin for leprosy be considered with all seriousness it deserves for  global leprosy.   And also longer and effective regimens for clearing the bacilli from the remaining leprosy patients of the world 

 

 

with best regards  

 

 

P. Narasimha Rao, MD, D.D, PhD

Professor of Dermatology, 

 

President- National IADVL 2019

Council member, IAL, 2018-19

Mobile-+91-9849044898

Email: dermarao@gmail.com

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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