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Risk of relapse in leprosy. The Leprosy Unit, WHO
Abstract:
Until the introduction by WHO of the standard regimens using multidrug therapy (MDT) for the treatment of leprosy, there was a general unwillingness to release patients from treatment. This was mainly due to the high risk of relapse after dapsone monotherapy. After almost a decade of MDT implementation and after releasing more than 4 million patients, it was necessary for WHO to review the risk of relapse following WHO-recommended MDT. The results of this study, carried out on more than 20,000 MB and 50,000 PB patients, revealed that the risk of relapse is very low, 0.77% for MB and 1.07% for PB, nine years after stopping MDT. In comparison to dapsone monotherapy, the risk is 10-times lower. Thus, over the last decade, MDT implementation has probably prevented close to half-a-million relapses.
Insights
The World Health Organization
Area of Science:
- Tropical medicine
- Infectious disease epidemiology
Background:
- Leprosy treatment historically involved prolonged therapy due to high relapse rates with dapsone monotherapy.
- The introduction of multidrug therapy (MDT) by the World Health Organization (WHO) aimed to improve treatment efficacy and reduce relapse risk.
- Over 4 million patients have completed MDT, necessitating a review of long-term relapse rates.
Purpose of the Study:
- To evaluate the risk of leprosy relapse after completion of WHO-recommended multidrug therapy (MDT).
- To compare relapse rates between MDT and previous dapsone monotherapy regimens.
Main Methods:
- Analysis of relapse data from over 20,000 multibacillary (MB) and 50,000 paucibacillary (PB) leprosy patients.
- Longitudinal follow-up of patients after stopping MDT treatment.
Main Results:
- The risk of leprosy relapse nine years after stopping MDT is low: 0.77% for MB and 1.07% for PB patients.
- MDT significantly reduces relapse risk by approximately tenfold compared to dapsone monotherapy.
- MDT implementation over the past decade is estimated to have prevented nearly half a million relapses.
Conclusions:
- WHO-recommended MDT is highly effective in preventing leprosy relapses.
- MDT represents a major advancement in leprosy control, offering a safer and more effective treatment strategy.
- The low relapse rates confirm the long-term benefits of MDT for leprosy patients worldwide.