FW: (LML) Single-dose rifampicin PEP increased the risk of MB disease

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Leprosy Mailing List – October 14,  2019

Ref.:  (LML) Single-dose rifampicin PEP increased the risk of MB disease 

From:  Geoff Prescott, Colchester, UK

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Dear Pieter,

We read with interest Dr. Almeida's contribution to the Leprosy Mailing List (LML) on 6^th October, Single-dose rifampicin PEP increased the risk of MB disease and Geoff Warne's response to this on October 9^th.

Firstly, as a long-standing ILEP member we support Mr. Warne's concern about "…whether there are groups of people that PEP will miss but who are still transmitting leprosy, and whether there are other transmission pathways which we are not thinking about."  This reflects disquiet among some ILEP members such as Lepra, that single-dose rifampicin (SDR-PEP) has shortcomings, summarised for example in Lockwood DNJ et al (2018) Single-dose rifampicin chemoprophylaxis protects those who need it least and is not a cost-effective intervention. [1]

As a consequence, currently not all ILEP members support the implementation of SDR-PEP; it is therefore not an ILEP collectively-endorsed approach. Even so, all members are engaged with the issue and as noted by Geoff Warne, ILEP's Technical Commission, "plans to examine these concerns in detail over the coming months." Therefore Dr. Almeida's contributions towards the SDR-PEP debate are certainly ones the leprosy community need to engage with and we look forward to the full publication of the research he outlined.

Secondly, while welcoming the WHO move towards evidence-based guidelines (2018), not all ILEP members endorse them.

Specific concerns remain around SDR-PEP and changes to the paucibacillary regimen as summarised by Lockwood DNJ et al (2019) Little evidence to support a major change in Paucibacillary leprosy treatment in the 2018 WHO guidelines."[2] Therefore we welcome the continuing discussion around these issues through the platform of the LML and in peer-reviewed journals such as Leprosy Review.

Lastly, in connection with the point above, we concur with Mr Warne's view that Dr Almeida's research would ultimately be well placed in a journal such as Leprosy Review. We do however disagree where Geoff Warne wrote, "...what Dr. Almeida has written is more than an opinion, it's a fully-fledged article with citations, "which Geoff Warne suggests should not be on the LML.

 

ILEP is a Federation of independent NGOs, so Mr. Warne's opinion, would perhaps have been better expressed as a personal opinion, as it is not the consensual view of the ILEP members. Lepra, for one, believes the advantage of the LML is that it enables new, different, interesting and professionally helpful pieces to be circulated.  The LML often has contributions referencing and citing evidence prior to contributions being developed into peer-reviewed articles. This is a helpful process to ensure that feedback garnered from the LML platform is taken into account. We believe that LML subscribers are quite capable of making judgements about the pieces they read. Just because a contribution has initial research findings and citations, it should not be excluded from this most stimulating platform.

Thank you for keeping the LML at the forefront of leprosy discussion.

 

Regards,

Geoff Prescott CEO, Lepra.

DL +44 (0) 1206 216 701

M +44 (0) 7410 939 993

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[1] Lockwood DNJ, Krishnamurthy P, Kumar B, Penna G (2018) Single-dose rifampicin chemoprophylaxis protects those who need it least and is not a cost-effective intervention. PLoS Negl Trop Dis 12(6): e0006403. https://doi.org/10.1371/ journal.pntd.0006403

[2] In press. Lockwood DNJ et al (2019) Little evidence to support a major change in paucibacillary leposy treatment in the 2018 WHO treatment guidelines. PLOs Negl trop Dis

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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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