Leprosy
Mailing List – September 25th, 2010
Ref.: Clofazimine
in high dosage used for the treatment of late ENL reaction in leprosy:
could it mask a relapse?
From:
Maria
Leide W. de Oliveira,
Rio de Janeiro
,
Brazil
Dear
Dr Noto,
I
have been following all the discussion regarding clofazimine with my
colleagues in LML and the following is my point of view:
1-
As reported by some Leprosy Control Program managers,
Brazil
too has been receiving loose clofazimine (100mg and 50mg capsules) for
the past years from WHO Geneva free of charge.
However, it is not a regular allocation and the total delivered
has been inferior to our requests.
For
this reason, the National Hansen’s Disease Control Program has
manifested the desire to buy loose clofazimine. Another
reason is to avoid the
misusing of MDT blister-packs by extracting the 50 mg clofazimine
capsules from the MB blister-packs and discarding the DDS and
rifampicine or using it for other purposes.
2-
In field work I use to prescribe clofazimine in many leprosy cases. As
in
Brazil
we have Thalidomide available and its dramatic effect in type 2
reaction is undoubtedly superior
to the action of clofazimine, I only use it in a high doses to treat
recurrent type 2 reactions, usually in late reaction after
polychemotherapy or in some young women. However, after my latest
experience with relapse cases I started wondering if clofazimine is
not masking relapse development and also, creating a risk of
clofazimine resistance due to its mono-therapy. We
must protect this wonderful drug from now on. Therefore,
I am avoiding giving clofazimine in late type 2 reactions and have
started observing those cases where clofazimine was given previously.
Best
regards,
Maria
Leide W. de Oliveira
Medical
School-UFRJ-Brazil
mleide(at)uol.com.br
- mleide(at)hucff.ufrj.br
