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Relapses in paucibacillary patients after treatment with three short-term regimens containing rifampin
K Katoch1, U Ramanathan, M Natrajan
1Central JALMA Institute for Leprosy (ICMR), Taj Ganj, Agra, India.
Abstract:
Three multidrug regimens all containing rifampin and dapsone have been tried for the treatment of 278 cases of paucibacillary leprosy. Regimen I was the one recommended by the WHO Study Group. Regimen II was the same as Regimen I with depsone alone continued for a further 6 months. Regimen III was the same as Regimen II but rifampin was given daily for the first 7 days. The patients were comparable with regard to disease classification, lepromin status, bacteriological status, and number of lesions. As reported earlier, the disease inactivity rates by 1 year of treatment were much greater with Regimens II and III than with Regimen I (94% and 97% vs 76%). Early reaction was seen in 6% of those in Regimen III and in none in Regimens I and II. Late reaction was observed in 9% of those in Regimen I and none in Regimens II and III. During 3 1/2 years of follow up, 13% of the cases in Regimen I, 1% in Regimen II, and 2% in Regimen III relapsed. Since the patients in the three regimens were otherwise comparable, it is concluded that the high inactivity rate, low relapse rate (1%-2%), and no early or late reaction as observed in Regimen II patients were because of adequate treatment.
Insights
Regimen II, a multidrug therapy for paucibacillary leprosy, demonstrated superior efficacy with high inactivity and low relapse rates compared to other regimens. This leprosy treatment offers better patient outcomes and fewer reactions.
Area of Science:
- Dermatology
- Infectious Diseases
- Public Health
Background:
- Leprosy, a chronic infectious disease, requires effective multidrug regimens for treatment.
- Paucibacillary leprosy presents a significant global health challenge, necessitating optimized therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of three multidrug regimens for paucibacillary leprosy.
- To compare disease inactivity rates, reaction incidence, and relapse rates among different treatment protocols.
Main Methods:
- A comparative study involving 278 patients with paucibacillary leprosy.
- Three regimens were tested: Regimen I (WHO recommended), Regimen II (extended dapsone), and Regimen III (daily rifampin for 7 days).
- Patients were comparable across disease classification, lepromin status, bacteriological status, and lesion count.
Main Results:
- Regimens II and III showed significantly higher disease inactivity rates (94% and 97%) than Regimen I (76%) by 1 year.
- Regimen II and III had minimal early or late reactions, unlike Regimen I (9% late reaction).
- Relapse rates were substantially lower in Regimens II (1%) and III (2%) compared to Regimen I (13%) over 3.5 years.
Conclusions:
- Regimen II, involving extended dapsone therapy, proved highly effective for paucibacillary leprosy.
- The observed high inactivity and low relapse rates in Regimen II suggest it is an adequate and superior treatment.
- Optimized multidrug regimens are crucial for improving leprosy treatment outcomes and reducing disease recurrence.