Friday, December 4, 2020

Fw: (LML) Monthly Rifampicin is adequate

 

 

Leprosy Mailing List – December 4,  2020

 

Ref.:  (LML) Monthly Rifampicin is adequate

 

From:   Diana Lockwood, London, UK

 

 

Dear Pieter,

 

I would like to thank Dr Narsimha Rao for his posting on Nov 23, 2020 wondering whether Rifampicin should be given as a daily medication. I have always been delighted that we have had such a low relapse rate with treating leprosy patients with a monthly dose of Rifampicin. We are fortunate that our drugs work well with this monthly dosing.

 

I have discussed this in my chapter on Chemotherapy of leprosy in the International Textbook of Leprosy chapter. (Lockwood 2019)

 

1.      The MDT Regimen was decided by a committee in 1982. (1)  

2.      Butlin and I have calculated that 15,253,582 leprosy patients have been reported to WHO since 1985. They have been treated with different MDTs all with a monthly Rifampicin component. The relapse rate has been about 1%.  So we have a large empirical study of the effectiveness of MDT.(2).

 

3.      There have been two large trials on U-MDT. In Brazil,  613 high BI patients were treated with either 6 or 12 months of MDT. The relapse rate was 1%.(3) (Penna 2017 ). The study by Manikam et al in 3,389 (2091 PB and 1298 MB) patients  and a follow- up of 5 years also showed that a monthly dose of Rifampicin was associated with good clinical outcomes and a low relapse rate (4)

4.      Butlin et al have done a long term follow up on patients treated with 6 months UMDT and had a relapse rate of 0  with a 7 year follow- up. . (5)

5.      The US recommendation for daily Rifampicin treatment is not supported by any published data.

6.      In London I have used the WHO monthly Rifampicin regimens with great success.

7.      The adverse effects with daily Rifampicin will be serious.  The most serious is that steroid doses have to be doubled when treating reactions because daily rifampicin induces cytochrome p45 enzymes. Another correspondent has noted the renal failure that is reported with treatment regimens using daily Rifampicin.

 

For all these reasons we can be confident of the adequacy of  monthly Rifampicin treatment.

 

Diana NJ Lockwood

Saba Lambert

 

London School of Hygiene & Tropical Medicine

Keppel St

London WC1E 7HT

 

Visit my blog http://dnjtravels.blogspot.co.uk/

 

1.     Lockwood DNJ Lockwood DNJ. Leprosy Treatment of leprosy in International Textbook of Leprosy ed Scollard D 2019

1.         WHO. Chemotherapy of leprosy for control programmes. WHO, Tech Rep Ser. 1982:675.

2.         Butlin CR, Lockwood DNJ. Changing proportions of paucibacillary leprosy cases in global leprosy case notification. Leprosy Review. 2020;91(3):255-61.

3.         Penna GO, Buhrer-Sekula S, Kerr LRS, Stefani MMA, Rodrigues LC, de Araujo MG, et al. Uniform multidrug therapy for leprosy patients in Brazil (U-MDT/CT-BR): Results of an open label, randomized and controlled clinical trial, among multibacillary patients. PLoS Negl Trop Dis. 2017;11(7):e0005725.

4.         Manickam P, Mehendale SM, Nagaraju B, Katoch K, Jamesh A, Kutaiyan R, et al. International open trial of uniform multidrug therapy regimen for leprosy patients: Findings & implications for national leprosy programmes. Indian J Med Res. 2016;144(4):525-35.

5.         Butlin CR, Pahan D, Maug AKJ, Withington S, Nicholls P, Alam K, et al. Outcome of 6 months MBMDT in MB patients in Bangladesh- preliminary results. Leprosy Review. 2016;87(2):171-82.

 

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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