Leprosy Mailing List – July 27th, 2007
Ref.:
Treatment of leprosy and of reactions
From:
Vijayakumaran P., India
Dear Dr. Gajadeera,
I refer to your message dated LML
July 24th, 2007.
1. Treatment of leprosy:
UMDT refers to three drugs (Dapsone, Rifampicin, Clofazimine)
for 6 months. When a
participating leprosy patient develops complication to any of these
drugs the patient is eliminated from the study (it should have been in
the protocol). Appropriate
alternate regimen should be given.
This alternate regimen need not be for 6 months. The duration of treatment may
be longer if 2 drugs (Rifampicin and clofazimine) are used. We used to give for 2 years in
such situations during 1980/1990s - initial MDT/FDT WHO sponsored
field trials in Karigiri.
WHO recommended alternative regimen can be tried for
treatment of leprosy. http://www.who.int/lep/resources/expert/en/index3.html
2. Treatment of Lepra reaction
Prednisolone is the drug of choice for treatment of any lepra
reaction with neuritis. I
suggest the following (two options).
a. Start prednisolone and clofazimine.
Clofazimine 100mg tds for one month, 100mg bd for one month,
100mg od, thereafter, after acute phase subsides taper prednisolone.
Continue clofazimine for 12 months.
b. Start prednisolone and thalidomide
Taper the dose of both drugs as per standard recommendations.
Observe standard precautions for thalidomide. This patient is a female in
child bearing age group. Teratogenicity
of thalidomide happens only when given during pregnancy. If she conceives after
stopping thalidomide treatment there is no risk of teratogenicity. Because of this reason this
drug is contraindicated in women in child bearing age group. If conception is avoided
during treatment it is safe.
The main issue is that adequate precaution is ensured. Please note that in some
countries there are also legal issues that regulate the use if this
drug.
Thank you for presenting this case.
Dr. P. Vijayakumaran
DFIT
India
