Clofazimine in high dosage used for the treatment of late ENL reaction in leprosy: could it mask a relapse?

Leprosy Mailing List – September 25^th, 2010

Ref.:   Clofazimine in high dosage used for the treatment of late ENL reaction in leprosy: could it mask a relapse?

From: Maria Leide W. de Oliveira, Rio de Janeiro, Brazil

---

Dear Dr Noto,

I have been following all the discussion regarding clofazimine with my colleagues in LML and the following is my point of view:

1- As reported by some Leprosy Control Program managers, Brazil too has been receiving loose clofazimine (100mg and 50mg capsules) for the past years from WHO Geneva free of charge.  However, it is not a regular allocation and the total delivered has been inferior to our requests.

For this reason, the National Hansen’s Disease Control Program has manifested the desire to buy loose clofazimine.  Another reason is to avoid the misusing of 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.

2- In field work I use to prescribe clofazimine in many leprosy cases.  As in Brazil we have Thalidomide available and its dramatic effect in type 2 reaction is undoubtedly  superior to the action of clofazimine, I only use it in a high doses to treat recurrent type 2 reactions, usually in late reaction after polychemotherapy or in some young women. However, after my latest experience with relapse cases I started wondering if clofazimine is not masking relapse development and also, creating a risk of clofazimine resistance due to its mono-therapy.  We must protect this wonderful drug from now on.  Therefore, I am avoiding giving clofazimine in late type 2 reactions and have started observing those cases where clofazimine was given previously. 

Best regards,

Maria Leide W. de Oliveira

Medical School-UFRJ-Brazil

mleide(at)uol.com.br - mleide(at)hucff.ufrj.br