Fw: (LML) Clofazimine risk?

 

Leprosy Mailing List – April 1,  2021

 

Ref.:  (LML) Clofazimine risk?

 

From:  Diana Lockwood, London, U.K.

 

Dear Pieter,

 

Risks associated with Clofazimine use need monitoring

 

We thank Dr Ruth Butlin for the thorough answer to her own question about the risk of cardiac conduction abnormalities associated with clofazimine.[1]

 

The risk of clofazimine causing cardiotoxicity fortunately appears to be very rare. An MSc student of ours at the London School of Hygiene and Tropical Medicine conducted a systematic review of the adverse effects of clofazimine in leprosy for their dissertation, and like Dr Butlin, found only the single case report of Choudhri et al relating to cardiac dysrhythmias. [2,3]

 

At the Hospital for Tropical Diseases in London we perform an ECG on all patients being treated with clofazimine for multi-drug resistant tuberculosis before starting treatment and after 2 weeks.

 

Clofazimine is associated with other significant adverse effects including skin and gastro-intestinal disturbance. In the Brazilian randomised trial of U-MDT skin pigmentation occurred in 10% and xerosis in 30% of patients taking Clofazimine. [4] Clofazimine-induced skin discolouration has an impact on adherence to MDT. Kumar et al found that 9.8% of patients taking MB-MDT stopped taking medication because of clofazimine pigmentation. [5]

 

The many adverse effects of clofazimine (and dapsone) require systematic monitoring which should be put in place for all patients taking anti- leprosy drugs. This is important since clofazimine is now being recommended for individuals diagnosed with paucibacillary leprosy.

 

The need for more rigorous adverse effect monitoring was discussed by us, Dr Butlin and others in our critique of the WHO leprosy treatment guidelines and Butlin's concerns add weight to this argument.[6,7]

 

Diana NJ Lockwood

Stephen L Walker

London School of Hygiene & Tropical Medicine,

London WC1E 7HT

 

 

1.    Clofazimine risk. Ruth Butlin. Leprosy Mailing List 24th March 2021

2.    Jesus, S. Adverse Effects of Clofazimine in the Management of Leprosy. A Systematic Review. 2019 MSc thesis.  London School of Hygiene and Tropical Medicine

3.    Choudhri Shurjeel H, Harris Louise, Jagadish W Butany, Keystone Jay S. Lepr Rev (1995) 66, 63-68

4.    Gonçalves Hde S, Pontes MA, Buhrer-Sekula S, Cruz R, Almeida PC, Moraes ME, et al. Brazilian clinical trial of uniform multidrug therapy for leprosy patients: the correlation between clinical disease types and adverse effects. Mem Inst Oswaldo Cruz. 2012;107 Suppl 1:74–8.

5.    Kumar A, Girdhar A, Chakma JK, Girdhar BK. WHO multidrug therapy for leprosy: epidemiology of default in treatment in Agra district, Uttar Pradesh, India. Biomed Res Int. 2015;2015:705804

6.    Lockwood DNJ, Lambert S, Srikantam A, Darlong J, Pai VV, Butlin CR, et al. (2019) Three drugs are unnecessary for treating paucibacillary leprosy—A critique of the WHO guidelines. PLoS Negl Trop Dis 13(10): e0007671. https://doi.org/10.1371/journal.pntd.0007671

7.    Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018

 

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

--
You received this message because you are subscribed to the Google Groups "Leprosy Mailing List" group.
To unsubscribe from this group and stop receiving emails from it, send an email to leprosymailinglist+unsubscribe@googlegroups.com.
To view this discussion on the web, visit https://groups.google.com/d/msgid/leprosymailinglist/88039c57-737c-4746-a009-25678b918bf7n%40googlegroups.com.