Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India

Abstract

A subset of multibacillary (MB) leprosy patients manifest with clinical "nonresponsiveness" to the fixedduration, World Health Organization multidrug therapy MB regimen (WHO-MDT-MBR). The aim of this retrospective study was to assess the effectiveness and safety of alternate anti-leprosy therapy (ALT) in such patients. This is an analysis of patients' records, registered in the leprosy clinic of our institute over a period of 6 years (2010-2015). The criteria for inadequate response/nonresponsiveness to treatment were as follows: 1) persistent/new lesions after completing ³ 12 months of WHO-MDT-MBR (isolated reactions were ruled out histopathologically) and 2) persistent positive/ increasing value of the morphological index (MI) and a 2 log increase in the bacteriological index (BI) after ³ 12 months of WHO-MDT-MBR. Such cases were treated with ALT consisting of minocycline, clofazimine, and ofloxacin (24 months). Of 556 patients registered during the study period, 40.3% (224) were slit-skin smear (SSS) positive and 59.7% (332) were SSS negative. Of all, 35 patients (6.3%) satisfied the criteria for clinical nonresponsiveness. Of 224 SSS-positive patients, these 35 patients amounted to 15.6%. The mean BI and MI of these patients after completion of ³ 12 months of WHO-MDT-MBR were 5.3 ± 0.6 and 14 ± 6.8%, respectively. After 6 months of treatment with ALT, MI became negative (0) in all these patients. After completion of ALT, the mean BI and MI became 1.7 ± 0.7 and 0%, respectively (P < 0.0001). There were 16 patients with corticosteroid-dependent recurrent/chronic erythema nodosum leprosum, who had excellent response with significant reduction in the number of reactional episodes and mean dose of prednisolone required (P < 0.0001). No serious adverse effects were noted. We conclude that ALT is safe and effective in the management of MB leprosy patients who are nonresponsive to 12 months of WHO-MDT-MBR.

Persistent plaques after release from treatment in slit‐skin smear negative leprosy patients: Wait and watch or adopt a proactive approach?

“…A subset of leprosy patients continue to have persistent plaques even after adequate multidrug therapy (MDT). [1][2][3] The lesions may improve partially during treatment but reappear within 2 to 3 months of stopping MDT. Some of these patients are diagnosed as type 1 leprosy reaction or late reversal reaction and are continued on corticosteroids; whereas in other scenarios (less erythema or infiltration in the lesions), the patients are counseled about the self-limiting nature of these lesions and are not offered any active treatment.…”

Comments in response to report on ‘Late reversal reaction with resistant Mycobacterium leprae: an emerging paradigm’

“…Tarun Narang 1 , Divya Kamat 2 , Sunil Dogra 3 and Bhushan Kumar 4 We have read with interest the case report by Sardana et al 'Late reversal reaction with resistant Mycobacterium leprae: an emerging paradigm'. 1 We agree with the authors as far as drug resistant M. leprae and its association with recurrent reactions is concerned.…”

Management of leprosy patients in the era of COVID‐19

“…Dapsone-induced esinophilic pneumonia has been reported in leprosy patients. 4 Alternate antileprosy regimen has been studied by Narang et al 5 with promising results in clinically "nonresponsive" patients to MDT of WHO. This regimen consisted of minocycline, clofazimine, and ofloxacin (24 months).…”