Leprosy
Mailing List – January, 27th, 2010
Ref.: Alternative
regimens for multi-drug therapy (MDT) in leprosy
From:
Diana Lockwood,
London
,
UK
Dear
Salvatore,
In
Reply to Dr Gilead's request (LML Jan. 19th, 2010).
The whole topic of alternative regimens for MDT is given too
little attention. I think
that the level of adverse effects due to dapsone has been under-recognised
and we are starting to see significant rates of adverse effects when
we look for them. Patricia
Deps (Lepr Rev. 2007 Sep;78(3):216-22.) has reported that 45% of
Brazilian patients had adverse effects with leprosy MDT, 43.8% to
Dapsone, 12.3% to Rifampicin and 9.2% to Clofazimine.
In a study I am currently doing in
India
we are also seeing significant rates of anaemia in patients on Dapsone.
If a patients cannot tolerate Dapsone or Clofazimine then using single
dose monthly Rifampicine, Ofloxacine and Minocicline (ROM) is an
option. The study which
gives one some confidence in using this is the study by Villarmosa et
al (Am J Trop Med Hyg 2004 70(2): 197-200) who compared monthly ROM
against MD-MDT in a group of BL and LL patients in the
Philippines
and they reported a satisfactory fall in the bacterial index (BI) of
these patients. We have
used this in a patients with LL who has liver failure.
After a year on treatment his BI is falling and he has not yet
had ENL.
I think that we should be doing larger studies to establish the role
of monthly ROM in the anti-bacterial treatment of leprosy in patients
with adverse effects or problems with compliance.
Diana
Diana
Lockwood
Professor of Tropical Medicine
London School of Hygiene & Tropical Medicine
Keppel St
London
WC1E 7HT
diana.lockwood
