Fixed-duration therapy (FDT) in multibacillary leprosy; efficacy and complications

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Dermatology

Background:

• The World Health Organization (WHO) established a multidrug therapy (MDT) regimen in 1982 for multibacillary (MB) leprosy.
• This regimen includes rifampin, dapsone, and clofazimine, with a minimum treatment duration of 2 years or until negative skin smears.
• Rifampin's high bacterial killing rate (99.9%) suggests MDT's potential for complete eradication and prevention of drug resistance.

Purpose of the Study:

• To evaluate the efficacy and long-term outcomes of the WHO multidrug therapy (MDT) regimen in multibacillary (MB) leprosy patients.
• To assess the incidence of lepra reactions during and after fixed-duration MDT.
• To determine relapse rates after completing the recommended 2-year MDT course.

Main Methods:

• A cohort of 360 smear-positive, previously untreated multibacillary leprosy patients received 2-year WHO/MDT.
• Lepra reactions were monitored during therapy and subsequent surveillance.
• Patients were followed for relapse over 886 person-years post-treatment.

Main Results:

• The bacterial index showed a continued decline even after the 2-year fixed-duration therapy.
• Lepra reactions occurred in 22.8% of patients during therapy and 10.7% during surveillance.
• No relapses were observed in any patient during the 886 person-years of follow-up.

Conclusions:

• Fixed-duration multidrug therapy (MDT) for multibacillary leprosy is highly effective, leading to sustained bacterial clearance.
• The 2-year WHO/MDT regimen appears adequate for achieving long-term remission and preventing relapse.
• Continued monitoring for lepra reactions is important during and after treatment completion.