(LML) Leprosy Post Exposure Prophylaxis, Thalidomide and Clofazimine

Leprosy Mailing List – July 16,  2019

Ref.:    (LML) Leprosy Post Exposure Prophylaxis, Thalidomide and Clofazimine

From:  Diana Lockwood, London, UK

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Dear Pieter,

Thanks to Dr Ramesh for the LML posting of July 9.

To answer his questions

1. Single dose Rifampicin given as LPEP.  Thanks for raising a query about this.  Several of us have outlined the shortcomings of this regimen and we published these concerns on the LML in Dec 2017and then published our letter in Plos NTD (see attached file). Firstly it only protects against PB leprosy, the protection is only for 2 years.  I think it is important that the recipients of PEP are aware of the limited nature of the protection they are receiving. 
   Leprosy programmes using this intervention have an ethical responsibility to tell the recipients of the short-term nature of the protection. To tell participants that they will be protected against leprosy is to give them unrealistic expectations.
   
   Yes, there a significant risk of M. leprae developing Rifampicin resistance. This is because the development of resistance has been averted by the successful use of 2 and 3 drug regimens in treatment
   
   2. Thalidomide availability varies hugely between countries. In India and Brazil, it is given to out-patients. In Indonesia and Ethiopia it is not available.  I think that as leprosy doctors we should be campaigning for Thalidomide to be made available to leprosy patients. Our study in Ethiopia where Thalidomide is not available finds that there is a 10% mortality there from steroid related complications.
   
   
   3. Clofazimine. I have also experienced significant numbers of patients developing unacceptable clofazimine pigmentation. I use monthly minofloxacin as a substitute and think that further work is needed in this area.
   
   BW
   
   Diana Lockwood
   
   Professor of Tropical Medicine

1. Lockwood, D.N.J. ; Krishnamurthy, P. ; Kumar, B. ; Penna, G. ; Single-dose rifampicin chemoprophylaxis protects those who need it least and is not a cost-effective intervention. PLoS Negl Trop Dis (2018) 12(6):e0006403;
2. The mortality associated with Erythema Nodosum Leprosum in Ethiopia: a retrospective hospital-based study.  Walker SL, Lebas E, Doni SN, Lockwood DN, Lambert SM.  PLoS Negl Trop Dis 2014;8(3)

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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

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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