Leprosy Mailing List – June 24, 2021
Ref.: (LML) Length of MDT
From: Diana Lockwood, London, UK
Dear Pieter,
This editorial written by myself, Gerson Penna and Ruth Butlin considers the latest data on the long term outcomes for patients treated with the WHO 12 month regimen in trials. ( 1) These patients had good outcomes with low relapse rates. Patients with high BI were also cured with these regimens. There is no need for patients with a high BI to have longer treatments. There is a newly published Brazilian study with important new evidence. They found ten cases of relapse in a cohort of 713 patients followed-up for a mean of 12.1 years giving in an incidence rate of 1.16 relapse cases per 1000 person-year (95% CI = 0.5915–2.076). The accumulated risk was 0.025 in 20 years. (2)
Patients' lesions can take a long time to improve and this should be explained to them. We encourage clinicians to trust these regimens.
Patients can have leprosy immune- mediated complications such as reactions and these can make the clinician and the patients feel that the leprosy is still active.
Neuropathic pain also needs to be asked about as another late complication.
We need further trials to find regimens with fewer adverse drug effects such as Rifampicin, Minocycline and Ofloxacin.
The paper can be found on this link. https://leprosyreview.org/article/92/2/20-21034
Best Wishes
Diana
Diana NJ Lockwood
Emeritus professor of Tropical Medicine
London School of Hygiene & Tropical Medicine
London WC1E 7HT
1. Lockwood, DNJ, Butlin CR, Penna GO Current leprosy Multi-drug Treatment durations for MB patient (12 months) produce good clinical outcomes over many years. Lepr Rev (2021) 92, 97–101
2. Nery JAC, Sales AM, Hacker M, Moraes MO, Maia RC, Sarno EN, et al. Low rate of relapse after twelve-dose multidrug therapy for hansen's disease: A 20-year cohort study in a Brazilian reference center. PLoS Negl Trop Dis. 2021;15(5):e0009382. accepted for publication.
3. Lockwood DNJ. Chronic aspects of leprosy-neglected but important. Trans R Soc Trop Med Hyg. 2019 Jan 31.
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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