Late relapses in leprosy patients in Brazil: 10-year post-trial of uniform multidrug therapy (U-MDT/CT-BR)

• Published in: The Brazilian journal of infectious diseases Vol. 28; no. 2; p. 103745
• Main Authors: Penna, Gerson Oliveira, Pontes, Maria Araci de Andrade, Talhari, Sinésio, Gonçalves, Heitor de Sá, Talhari, Carolina, Pessoa, Allen de Souza, Pedroza, Valderiza, Bührer-Sékula, Samira, Stefani, Mariane Martins de Araujo, Penna, Maria Lucia Fernandes
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01.03.2024; Contexto; Elsevier; Brazilian Society of Infectious Diseases
• Subjects: Clinical trial; Diseases; Drug therapy; Drug therapy, Combination; INFECTIOUS DISEASES; Leprosy; Original; Patient outcomes; Relapse; Statistics; Uniform multidrug therapy; Brazil; Leprosy; Uniform multidrug therapy; Clinical trial; Relapse
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2024.103745

Leprosy is a neglected dermato-neurologic, infectious disease caused by Mycobacterium leprae or M. lepromatosis. Leprosy is treatable and curable by multidrug therapy/MDT, consisting of 12 months rifampicin, dapsone and clofazimine for multibacillary/MB patients and for 6 months for paucibacillary/PB patients. The relapse rate is considered a crucial treatment outcome. A randomized Controlled Clinical Trial (U-MDT/CT-BR) conducted from 2007‒2012 compared clinical outcomes in MB patients after 12 months regular MDT/R-MDT and 6 months uniform MDT/U-MDT in two highly endemic Brazilian areas. To estimate the 10 years relapse rate of MB patients treated with 6 months U-MDT. The statistical analyses treated the data as a case-control study, sampled from the cohort generated for the randomized trial. Analyses estimated univariate odds ratio and applied logistic regression for multivariate analysis, controlling the confounding variables. The overall relapse rate was 4.08 %: 4.95 % (16 out of 323) in the U-MDT group and 3.10 % (9 out of 290) in the regular/R-MDT group. The difference in relapse proportion between U-MDT and R-MDT groups was 1.85 %, not statistically significant (Odds Ratio = 1.63, 95 % CI 0.71 to 3.74). However, misdiagnosis of relapses, may have introduced bias, underestimating the force of the association represented by the odds ratio. The relapse estimate of 10 years follow-up study of the first randomized, controlled study on U-MDT/CT-BR was similar to the R-MDT group, supporting strong evidence that 6 months U-MDT for MB patients is an acceptable option to be adopted by leprosy endemic countries worldwide. ClinicalTrials.gov: NCT00669643.