DAILY MULTIDRUG THERAPY FOR LEPROSY - RESULTS OF A 14-YEAR EXPERIENCE

Between 1980 and 1994, 67 new or relapsing leprosy patients were treat ed by daily administered multidrug regimens. Tuberculoid patients (23 TT/BT) received either bitherapy [rifampin+dapsone or clofazimine (RMP +DDS or CLO)] or tritherapy [RMP+DDS and/or CLO and/or ethionamide (ET H)] until clinical cure. Lepromatous patients (44 BB/BL/LL) received t ritherapy (RMP+DDS and/or CLO and/or ETH) at least until bacteriologic al negativity. Of the 23 tuberculoid patients only one patient (5%) wa s cured at 6 months and about 70% needed between 6 and 23 months of tr eatment to obtain clinical cure (mean 19.5 months). In the 44 lepromat ous patients, the achievement of bacteriological negativity was signif icantly linked to the initial bacterial index (BI), and it occurred af ter 2 to 7 years (mean 66.5 months) of multidrug therapy (MDT). The av erage BI decrease per year was 1.1+ during the first year, 0.9+ the se cond year, and then < 0.5+ per year. Reactional states significantly ( p < 0.01) influenced the BI course: reversal reactions (RR) accelerate d while erythema nodosum leprosum (ENL) delayed the BI decrease. Three of the 23 (13%) tuberculoid and 19 of the 44 (43%) lepromatous patien ts (p < 0.02) exhibited a RR and 18 of 44 (41%) lepromatous patients h ad ENL during MDT. A late RR (LRR) was observed in 1 (5%) and 6 (17%) of our tuberculoid and lepromatous patients, respectively, and 3 (8%) of our lepromatous patients suffered post-MDT ENL. No confirmed relaps e has been observed within a follow-up period of 6 months to 7 years a nd 3 months [59 person-years at risk (PYR)] for TT/BT patients and of 4 months to 5 years and 10 months (100 PYR) for BB/BL/LL patients. Whe n compared to the recommended WHO/MDT, it appears that daily MDT does not increase the clinical or the bacteriological cure rates either at 6 months in paucibacillary tuberculoid patients or at 2 years in multi bacillary lepromatous patients. Moreover, as does the WHO/MDT, our reg imens show a high frequency of reactional states both during and after treatment. This fact constitutes the main new problem of the actual t reatment of leprosy.