Leprosy Mailing List – November 26, 2020
Ref.: (LML) Replacing opinions about leprosy treatment with research
From: P. Narasimba Rao, Hyderabad, India
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Dear Pieter,
I thank you for forwarding the comment of Dr Theuvenet ("Just to be clear; you recommend then rifampicin 600 mg OD., is that correct?"). It is an honour to respond.
To keep the answer simple: yes, I recommend that we need to study the efficacy of daily dose Rifampicin of 10-20 mg/kg.day (max 600 mg) for 12/24 months (as part of MDT in addition to from Dapsone and clofazimine) in leprosy patients. I would like to elaborate little more on it, please!
The first reason being, from very long time such a regimen with daily rifampicin is being used in patients at USA as a part of the national programme successfully, apparently with good acceptance. The intension for the such a regimen must only be to clear the bacilli effectively. And must have been well thought out as well!
Secondly, in this part of world (India) we are finding more and more patients with advanced forms of lepromatous leprosy with varied presentations. Some of them despite full treatment with WHO MDT for 12 months, are showing florid activity which is making many of the workers search for alternative regimens and more effective bactericidal drugs.(Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India. DOI: https://doi.org/10.4269/ajtmh.18-0256 ).
Third, the global leprosy load has reduced from 14 million from 1982 to about 0.2 million in 2019. And as the leprosy is regressing, more and more lepromatous / high bacillary forms remain (it is being observed pan India) and need to be tackled with more effective MDT, and not necessarily by what was designed for global leprosy of year 1982. There is a need for new template.
Persistent activity and non resolution/ no-significant reduction in clinical, bacteriological or histological parameters after completion with present recommend MDT in some percentage of patients with initial high BI is a reality. Many clinicians are already looking at Alternate anti-leprosy regimen of 18 months (WHO recommendation in cases of Rifampicin resistance) in such cases, which is very worrisome, as its efficacy is still unproven and may be unnecessary too.
While search is on for more effective/ new chemo-therapeutic agent/ regimen, it would only be prudent to attempt a regimen already tried and tested in good number of patients, which is the Rifampicin in daily-dosage as a part of MDT.
Of course, more evidence need to be generated. But then for it to happen, such an idea has to accepted/considered first. And alternative ideas should be welcome.
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
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << edit...@gmail.com
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