A Comparative Clinical Trial in Multibacillary Leprosy with Long-Term Relapse Rates of Four Different Multidrug Regimens

Fajardo, T. T.; Villahermosa, Laarni G.; Pardillo, Fe Eleanor F.; Abalos, Rodolfo M.; Burgos, Jasmin; Cruz, Eduardo Dela; Gelber, Robert H.

doi:10.4269/ajtmh.2009.81.330

Cited by 24 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mean BIs and reaction rates of the patients who received 12 doses (n = 128) were similar to those treated with 24 doses (n = 85) of MDT [63]. This study and others were interpreted to indicate that the reduction to 12 doses did not compromise MDT effectiveness [45,64].…”

Section: Clinical Trials With Standard Who-mdtmentioning

confidence: 89%

“…As a result, there are wide variations in relapse rate estimations after establishment of 'cure' criteria by the current WHO-MDT policy [22]. These estimations range from zero in the 502 patients of the AMFES cohort in Ethiopia after a follow-up period of up to 8 years after completion of fixed-dose MDT [43], 1.84% in an 18-year follow-up period of 163 patients in India [49] to 2% in patients treated with up to 2 years of WHO-MDT [45,50]. Since most studies report less than 1%, relapse in MB patients is considered to be very low as a result of nearly 30 years of the widespread use of MDT [39].…”

Section: ■ Relapsementioning

confidence: 99%

“…Various researchers agree there is a subset of MB patients, particularly those at the lepromatous pole of the spectrum and those with a high bacterial burden, who are at substantial risk for relapse [42][43][44][45]. Other risk factors include inadequate therapy and immunosuppression [22,[46][47][48].…”

Section: ■ Relapsementioning

confidence: 99%

See 2 more Smart Citations

Considerations on clinical trials of leprosy treatment: need of novel drug combinations

Illarramendi¹,

Oliveira²,

Sales³

et al. 2013

Clinical Investigation

View full text Add to dashboard Cite

Considering that after 30 years of using multidrug therapy (MDT), leprosy eradication has still not been achieved, leprosy treatment must remain on the drug discovery agenda. Due to the complexities inherent in leprosy disease and the many methodological issues involved in clinical trials, the task of translating the bench findings into clinical practice has been arduous. While the effectiveness of reducing the currently recommended MDT remains controversial, a number of highly bactericidal antibiotics and immune-modulatory drugs have emerged as prospective candidates to improve patient adherence and quality of life, reduce adverse effects and prevent resistance. To replace the standard WHO-MDT, the new combination must be the shortest, simplest and, consequently, most affordable treatment possible.

show abstract

Section: Clinical Trials With Standard Who-mdtmentioning

confidence: 89%

Section: ■ Relapsementioning

confidence: 99%

See 1 more Smart Citation

Considerations on clinical trials of leprosy treatment: need of novel drug combinations

Illarramendi¹,

Oliveira²,

Sales³

et al. 2013

Clinical Investigation

View full text Add to dashboard Cite

show abstract

“…It is the MB form of HD that is responsible for significant transmission of the disease. However, there is controversy regarding whether 12‐month MDT is as effective as 24‐month MDT …”

Section: Introductionmentioning

confidence: 99%

“…However, there is controversy regarding whether 12-month MDT is as effective as 24-month MDT. 3,4 Operational changes that may have had an adverse impact on the control of HD have also occurred. Since 1996 there has been no system of follow-up after the end of treatment for either MB or paucibacillary (PB) cases.…”

Section: Introductionmentioning

confidence: 99%

Current trends in leprosy transmission in eastern India in the era of 12‐month multi‐drug treatment: a hospital‐based retrospective study

Ghosh

Panda

2013

Int J Dermatology

View full text Add to dashboard Cite

show abstract

Antimycobacterial Drugs

Gillespie¹,

Murphy²

2011

Encyclopedia of Life Sciences

View full text Add to dashboard Cite

Antimycobacterial drugs are used in the treatment of diseases caused by members of the Mycobacterium genus, including tuberculosis (TB) and leprosy, which have affected man since antiquity, and the nontuberculous mycobacterioses (NTM) that are increasingly recognised. Combination chemotherapy is essential to kill heterogeneous populations of bacterial cells located in different conditions within the host, and to prevent drug resistance. Although combination therapy has been effective in controlling leprosy, the global HIV epidemic and the emergence drug resistance are undermining efforts to control TB. Currently available chemotherapeutic agents are highly effective in managing drug‐sensitive TB, however, the development of new antimycobacterial drugs to manage both drug‐sensitive and drug‐resistant disease is a global health priority. These drugs must be safe, effective and affordable in resource‐limited countries most burdened by TB disease. NTMs are increasingly being identified as human pathogens in both non‐ and immunocompromised patients; more evidence for the most efficacious treatments is required. Key Concepts: Tuberculosis is global health priority with 9 million active cases, and 1.7 million deaths each year, of whom 0.5 million are coinfected with HIV; with 1 in 3 people latently infected globally, there is a huge pool of potential future infection. Mycobacteria are unusual; they are slow growing with a thick waxy cell wall made of lipid rich material which makes penetration by drugs problematic. At any one time, there may be heterogeneous populations of mycobacterial cells in different metabolic states; these may be targeted by different antimycobacterial drugs. Antimycobacterial drugs are used for the treatment of mycobacterial infections, including tuberculosis, leprosy and nontuberculous mycobacateria; the greatest burden of disease is borne by developing countries with limited resources. Combination treatment is required for prolonged periods, usually 6 months or more, to kill heterogeneous mycobacterial cells in different locations within the host, and to prevent resistance developing. Drug resistance develops through spontaneous mutations in the chromosomal DNA. Exposing mycobacteria to monotherapy selects out these resistant strains, as may happen when patients are nonadherent with prescribed therapy. Drug resistance is a major problem in the control of tuberculosis globally; 5% resistant to both rifampicin and isoniazid (MDRTB) the backbones of currently recommended chemotherapy, with around 10% of those also resistant to fluoroquiniolones and second line agents (XDR TB). Leprosy elimination programmes have successfully reduced the prevalence of the disease; patients are rendered noninfectious after the first dose of medication. Nontuberculous mycobacteria are emerging as important human pathogens; there is a pacuity of robust evidence for their optimal management. A large number of new agents with novel mechanisms of action are being trialled to assess their efficacy in treating mycobacterial disease.

show abstract

A Comparative Clinical Trial in Multibacillary Leprosy with Long-Term Relapse Rates of Four Different Multidrug Regimens

Cited by 24 publications

References 22 publications

Considerations on clinical trials of leprosy treatment: need of novel drug combinations

Considerations on clinical trials of leprosy treatment: need of novel drug combinations

Current trends in leprosy transmission in eastern India in the era of 12‐month multi‐drug treatment: a hospital‐based retrospective study

Antimycobacterial Drugs

Contact Info

Product

Resources

About