Low rate of relapse after twelve-dose multidrug therapy for hansen’s disease: A 20-year cohort study in a brazilian reference center

Abstract

The World Health Organization has raised concerns about the increasing number of Hansen disease (HD) relapses worldwide, especially in Brazil, India, and Indonesia that report the highest number of recurrent cases. Relapses are an indicator of MDT effectiveness and can reflect Mycobacterium leprae persistence or re-infection. Relapse is also a potential marker for the development or progression of disability. In this research, we studied a large cohort of persons affected by HD treated with full fixed-dose multibacillary (MB) multidrug therapy (MDT) followed for up to 20 years and observed that relapses are a rare event. We estimated the incidence density of relapse in a cohort of patients classified to receive MB regime (bacillary index (BI) > 0), diagnosed between September 1997 and June 2017, and treated with twelve-dose MB-MDT at a HD reference center in Rio de Janeiro, Brazil. We obtained the data from the data management system of the clinic routine service. We linked the selected cases to the dataset of relapses of the national HD data to confirm possible relapse cases diagnosed elsewhere. We diagnosed ten cases of relapse in a cohort of 713 patients followed-up for a mean of 12.1 years. This resulted in an incidence rate of 1.16 relapse cases per 1000 person-year (95% CI = 0.5915–2.076). The accumulated risk was 0.025 in 20 years. The very low risk observed in this cohort of twelve-dose-treated MB patients reinforces the success of the current MDT scheme.

Antimicrobial Resistance among Leprosy Patients in Brazil: Real-World Data Based on the National Surveillance Plan

“…This result was similar to findings in Malaysia (18), France (6), and the Ivory Coast (19) but different from findings in China (20) and India (16), where rifampin resistance was more frequent. The frequency of isolated resistance to rifampin and ofloxacin was considered very low, in contrast to results reported in India (7); however, our findings were similar to those in studies by Wahyuni et al (17) and Chen et al ( 5) Our results support the effectiveness of disease control actions according to the WHO-MDT regimen (8).…”

“…Despite these reports, it is still unknown whether AMR affects the maintenance of disease burden. The 12-dose regimen of WHO-MDT is highly effective (8), and it has been successful in the treatment of cases of isolated resistance to dapsone (9). Brazil is among the 23 countries with the highest burdens of the disease, and in 2019, it was responsible for 13.7% of new cases and 43.5% of relapse cases worldwide (2).…”

Autochthonous North American Leprosy: A Second Case in Canada

“…In retrospect, however, this may not have been required as multiple follow-up studies have demonstrated low rates of relapse with the 12-month regimen which are similar to relapse rates seen with a 24-month regimen [ 23 , 24 ]. The probability of relapse, much like the risk of progression to infection after exposure to M. leprae , is likely related to genetic components that are not entirely understood [ 25 , 26 ].…”

Gene expression patterns associated with multidrug therapy in multibacillary leprosy

“…MDT has been effective against leprosy and patients are cured after the completion of MDT with low rates of relapses (Nery et al, 2021). Nevertheless, leprosy reactions and permanent disability have been observed in many patients (White and Franco-Paredes, 2015;Nery et al, 2021).…”

“…MDT has been effective against leprosy and patients are cured after the completion of MDT with low rates of relapses (Nery et al, 2021). Nevertheless, leprosy reactions and permanent disability have been observed in many patients (White and Franco-Paredes, 2015;Nery et al, 2021). In this scenario, it is important to better understand why some patients do not have a significant decrease in BI levels, especially because this can be a risk factor for reactional states and consequently high morbidity after release.…”