Effectiveness of MDT in multibacillary leprosy

Area of Science:

• Medical Science
• Infectious Diseases
• Dermatology

Background:

• Leprosy remains a significant public health concern, particularly multibacillary (MB) leprosy.
• The World Health Organization multidrug therapy (WHO/MDT) is the standard treatment for leprosy.
• Evaluating WHO/MDT effectiveness and safety under real-world field conditions is crucial.

Purpose of the Study:

• To assess the long-term efficacy and tolerability of two WHO/MDT regimens for multibacillary leprosy.
• To evaluate the relapse rate and patient outcomes after over a decade of follow-up.
• To determine the safety profile and acceptability of WHO/MDT in a large patient cohort.

Main Methods:

• A cohort of 1067 multibacillary leprosy patients received one of two WHO/MDT regimens.
• Regimen 1: Supervised monthly rifampin (RFP) and clofazimine (CLO) on two days, plus unsupervised diacetyl diaminodiphenylsulfone (DADDS) and dapsone (DDS).
• Regimen 2: Conventional MDT with supervised monthly RFP and CLO, plus unsupervised daily DDS and CLO. Follow-up exceeded 10 years (8244 person-years).

Main Results:

• A zero relapse rate was observed over 10 years of follow-up.
• Both WHO/MDT regimens demonstrated high acceptability and were well-tolerated with minimal complications.
• A decrease in bacterial index (BI) was noted, and skin discoloration from clofazimine resolved within a year post-treatment. Reactions occurred in 67% during treatment and 11% post-treatment.

Conclusions:

• WHO/MDT is a highly effective and safe treatment for multibacillary leprosy under field conditions.
• The study validates the WHO/MDT approach, demonstrating its long-term success in preventing relapses.
• The findings support the continued use and implementation of WHO/MDT for leprosy control globally.