Fixed-duration therapy in leprosy: Limitations and opportunities

Abstract

Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed-duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health-care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens.

Caregivers’ views on stigmatization and discrimination of people affected by leprosy in Ghana

“…This tendency reinforces stigma associated with the disease [ 29 ]. Besides, it is an affront to the World Health Organisation’s (WHO) encouragement for the integration of leprosy into the general health service where leprosy patients should be treated in the same outpatient department as those with any other disease [ 30 ]. This can signal to the patients and their communities that leprosy is not a 'different' disease.…”

The dermlep study I: results of prospective nation-wide survey of the number & Profile of leprosy patients seen by dermatologists in India

“…It is known that the limitations associated with fixed duration MDT is the continued visibility of a clinically active patch in a proportion of patients and continued inflammatory response resulting in persistent clinical activity for up to 12-18 months. [ 21 ] In our study, 9.32% ( n = 66) of post RFT patients visited dermatologists because of lepra reactions, while 11.58% ( n = 82) patients presented due to persistent neuritis. In a study from Brazil in RFT patients, it was observed that T1R was most common in 37.1%, followed by T2R in 18.6% and neuritis in 13.9%.…”

Current situation of leprosy in India and its future implications

“…The efficacy of pulse rifampicin, ofloxacin, and minocycline (ROM) as an alternative/additional regimen to treat multibacillary leprosy patients who refuse clofazimine needs to be evaluated. [ 34 ] In addition, with increasing multibacillary leprosy load in the community and severe forms of lepromatous leprosy with high initial bacillary load being diagnosed across the country, there is an urgent need to review the current guidelines of “fixed duration therapy” (FDT) for all types of multibacillary leprosy. It is also important to recognize that leprosy can be associated with other comorbidities such as tuberculosis, HIV, and diabetes which could affect clinical manifestations and complications; hence, therapeutic management strategies need to be tailored to such situations.…”