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Six months fixed duration multidrug therapy in paucibacillary leprosy: risk of relapse and disability in Agra PB
Anil Kumar1, Anita Girdhar, Bhavneswar Kumar Girdhar
1Department of Biostatistics and Epidemiology, National JALMA Institute for Leprosy, Agra, Uttar Pradesh, India.
Background:
Many studies have focused on multidrug therapy (MDT) for multibacillary (MB) leprosy and rarely on long-term outcome of paucibacillary (PB) leprosy having recommendation of therapy for 6 months fixed duration therapy for PB patients. Studies on measuring risk of disability are rare. The present study is to assess the cure; default, relapse and disability in a prospective cohort of PB leprosy during follow-up of >4 years after treatment.
Design:
Prospective.
Setting:
Primary in our field area of Agra District.
Participants:
920 PB leprosy patients entered the study, 621 completed treatment, 599 followed finally including 271 males, no ethnic differentiation, patients of all age groups except for children below 5 years and old persons above 70 years were not included.
Treatment:
6 months fixed duration MDT as recommended by WHO.
Primary And Secondary Outcomes:
Treatment completion, cure, relapse and development of disability based on clinical assessment by well-experienced doctors.
Statistical Methods:
Data have been analysed using SPSS software, risk is computed as incidence per 100 person-years (PY) and test of significance used.
Results:
Study reports 91% cure rate. Incidence of relapse was 1.3/100 PY with no significant variation by age, sex, delay in detection, patches and nerves. Crude incidence of disability was 2.2% and varied significantly by age and nerve thickening but not by sex, number of patches, nerves and delay in treatment. Incidence of disability was 0.50/100 PY in treatment completed and 0.43 among defaulters.
Conclusion:
The study concludes that relapses do occur after MDT treatment but at the level of 1-2%, incidence of disability remains low (<1/100 PY) in PB leprosy. Low incidence of relapse and disability suggests that 6 months therapy is quite effective. However, further improvement may help to improve its efficacy. Longer follow-up may add to efficacy measures.
Insights
Paucibacillary leprosy patients treated with 6-month multidrug therapy show a high cure rate. Relapse and disability incidence remain low, indicating the therapy
Area of Science:
- Leprosy Research
- Infectious Diseases
- Public Health
Background:
- Limited long-term outcome data exist for paucibacillary (PB) leprosy treated with fixed-duration multidrug therapy (MDT).
- Risk assessment for disability following PB leprosy treatment is rarely studied.
- This study addresses the long-term outcomes of PB leprosy patients post-treatment.
Purpose of the Study:
- To prospectively assess cure rates, default, relapse, and disability in PB leprosy patients.
- To evaluate the long-term effectiveness of 6-month fixed-duration MDT for PB leprosy.
- To analyze risk factors associated with disability development after PB leprosy treatment.
Main Methods:
- Prospective cohort study in Agra District, India.
- 920 PB leprosy patients initiated 6-month MDT; 599 were followed for over 4 years.
- Outcomes (cure, relapse, disability) assessed clinically; data analyzed using SPSS.
Main Results:
- A 91% cure rate was observed.
- Relapse incidence was 1.3 per 100 person-years, with no significant variations by demographic or clinical factors.
- Crude disability incidence was 2.2%, significantly associated with age and nerve thickening.
Conclusions:
- Six-month MDT for PB leprosy demonstrates high efficacy with low relapse (1-2%) and disability rates (<1 per 100 PY).
- The current MDT regimen is effective, but further improvements could enhance outcomes.
- Extended follow-up periods are recommended to further validate treatment efficacy.
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