Leprosy Mailing List – January 18, 2020
Ref.: (LML) Dapsone allergy and MB treatment
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
Thanks to Dr. Shen Jianping for his very relevant question regarding Dapsone allergy and multidrug MB treatment (LML, January 6, 2020). I think it is good that all Chinese leprosy patients are checked for the 1301 gene-locus. Dapsone Syndrome is a terrible occurrence. But as pointed out having this gene locus does not always lead to the Dapsone syndrome.
Treating Multibacillary patients with only 2 drugs was at start of the MDT considered insufficient with no clinical evidence. But we know now that highly positive patients in a high endemic area after many years may relapse. Even in non-endemic area's as the Netherlands, we have seen relapses we considered from persisters. We still do not know how we can eradicate those persisters. Except maybe with a preventive treatment. Then still resistance may have occurred.
The paper from Yunnan fits in with my own feeling. PB as WHO advised will be treated with 3 drugs with the mentioned locus they will get 2 drugs. Which most likely will be enough. But my feeling is Rifampicine with Clofazimine together is not enough for MB patients. Without proper evidence, the WHO has neither, I would add minocycline or another 3rd drug. And then still we may have relapses.
My excuses for this personal answer, I think we have no sufficient evidence from trials and worse no good follow up.
We wish you a good Chinese New Year
Dr Ben Naafs
Dermatovenerologist
Leprologist since 1973. Ethiopia, Zimbabwe, The Netherlands, Brazil. Tanzania
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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