Can loose clofazimine be made available for the treatment of erythema nodosum leprosum (ENL) reaction?

Leprosy Mailing List – May 2^nd, 2010

Ref.: Can loose clofazimine be made available for the treatment of erythema nodosum leprosum (ENL) reaction?
From: Pieter de Koning, Würzburg, Germany

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Dear Sirs,

We regularly get questions from our staff in the field regarding the availability of loose clofazimine (or lamprene 100 mg caps and 50 mg caps) for the treatment of ENL reaction in leprosy. Clofazimine in high dosage (sometimes in combination with prednisolone) is recommended by WHO for those cases not responding to prednisolone alone or those cases where prednisolone is contra-indicated.

There used to be a time when loose clofazimine was available for this use (from CIBA GEIGY, now NOVARTIS) and provided free of charge by WHO. Nowadays it seems it is no longer available, although still recommended in (inter-)national guidelines. Field workers therefore revert to not using clofazimine for ENL at all or misusing MDT blister-packs by extracting the 50 mg clofazimine capsules from the MB blister-packs and discarding the DDS and rifampicine or using it for other purposes. Surely this cannot be an acceptable state of affairs.

Therefore my question is whether loose clofazimine can be made available again and what are the steps to be taken (who to approach?) in order to procure it.

Kind regards,

Dr. Pieter de Koning, MD, MPH

Medical Advisor

Deutsche Lepra- und Tuberkulosehilfe e.V (DAHW)

Mariannhillstraße 1c, 97074 Würzburg

Telefon: ++49 (0)931 7948-113, Fax: -160

E-mail: pieter.de-koning(at)dahw.de