Fw: Ref.: (LML) Fixed duration multidrug therapy (12 months) in leprosy patients with high bacillary load – Need to look beyond

 

Leprosy Mailing List – August 3,  2023

 

Ref.:  (LML) Fixed duration multidrug therapy (12 months) in leprosy patients with high bacillary load – Need to look beyond

 

From:  Sandra Durães, Brasília, Brazil

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Dear colleagues,

Just a few thoughts about the article:

Narang T, Almeida JG, Kumar B, Rao PN, Frade MAC, et al. Fixed duration multidrug therapy (12 months) in Hansen's disease patients with high bacillary load – need to look beyond. Indian J Dermatol Venereol Leprol doi: 10.25259/IJDVL_278_2023

The control and elimination of Hansen' disease is a major challenge. Permanent health education, such as strategies to increase the examination of contacts, to face the stigma and social vulnerabilities of the affected people, and the continued training of professionals, are important measures necessary to achieve better results.

This is yet another opinion article based on a peculiar interpretation of literature data. Despite the fact that definitions of cure, reaction and relapse are not uniformly adopted in the studies, evidence as to the efficacy and sufficiency of the 12 doses is broad. Patients who do not respond to the standard 12-dose regimen should undergo antimicrobial resistance testing.

We are all outraged by the endemic levels and the suffering of the affected people. We certainly need to increase the therapeutic arsenal with more effective drugs, but this return to the past with unnecessary extension of treatment is equally worrying.

Among the many interpretations of the data in the literature, one particularly intrigued me, the one that says "the U-MDT study from Brazil showed seven times more relapses in the 6-month regimen (U-MDT) in comparison to 12 months of treatment ( FD-MDT)". I would like to kindly ask the authors to explain how they reached this conclusion based on the results and methodological and statistical analyses of the research.

Best regards,

 

Sandra Durães 

General Coordination for Surveillance of Diseases in Elimination (CGDE) 

Health and Environment Surveillance Secretariat (SVSA) 

Ministry of Health, Brazil 

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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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