(LML) 2018 WHO Guidelines for the treatment of leprosy

Leprosy Mailing List – March 26, 2019

Ref.:   (LML) 2018 WHO Guidelines for the treatment of leprosy

From:  Pieter Schreuder, Maastricht, the Netherlands

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Dear colleagues,

Recently, when we as editors, did some reading to prepare for our LML letter of March 5, 2019 - (LML) Skin Smear Services neglected – we came across the 2018 WHO guidelines for the treatment of leprosy. I am not sure if everyone is aware of these new guidelines and if they already have been introduced in the field: PB 3-drug regimen for 6 months? In the same guidelines, it was concluded that presently there is not enough evidence (because of a potential increase in the risk of relapse) to shorten the recommended treatment duration for MB leprosy. It is generally agreed that one has to wait a minimum of 10 to 15 years before one can draw conclusions regarding MB relapse rates.

The new Guidelines for the diagnosis, treatment and prevention of leprosy. ISBN: 978 92 9022 638 3 © World Health Organization 2018. World Health Organization. Regional Office for South-East Asia. http://www.who.int/iris/handle/10665/274127.

Summary of recommendation:

• Treatment of leprosy:

The guidelines recommend a 3-drug regimen of rifampicin, dapsone and clofazimine for all leprosy patients, with a duration of treatment of 6 months for PB leprosy and 12 months for MB leprosy. This represents a change from the current standard treatment for PB leprosy.

For MB leprosy, the current standard treatment is a 3-drug regimen for 12 months. Evidence on the potential benefits and harms of a shorter (6-month) 3-drug regimen was limited and inconclusive, with a potential increase in the risk of relapse. Therefore, the GDG determined that there was not enough evidence of equivalent outcomes to support a recommendation to shorten the treatment duration for MB leprosy.

In the introduction to our letter of March 5, 2019 – Skin Smear Services neglected – we wrote that "we have serious worries about the quality (and quantity) of skin smear services in many endemic countries. Several LML authors have been pointing this out in recent months." We hope, that at the coming ILA congress, this problem is taken seriously.

Best wishes,

Pieter AM Schreuder

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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 << editorlml@gmail.com