Original Article

Evaluation of Multi-Drug Therapy for Leprosy in the United States Using Daily Rifampin

Authors: Mara M. Dacso, MD, MS, Robert R. Jacobson, MD, PhD, David M. Scollard, MD, PhD, Barbara M. Stryjewska, MD, John F. Prestigiacomo, MD

Abstract

Objectives: To evaluate the occurrence of relapse of multibacillary leprosy after multi-drug treatment including daily rifampin.


Methods: A retrospective review was performed utilizing data from the National Hansen's Disease Program (NHDP) on patients with leprosy treated and followed from 1988-1997 who received multi-drug therapy including daily rifampin. The occurrence of relapse in this cohort was measured, and demographic data and various clinical variables were also gathered.


Results: Ultimately, 158 cases fulfilled the eligibility criteria. 77% of cases were multibacillary patients and were treated with 2 or 3 drug protocols at rates of 36% and 35% before and after 1992, respectively. Only one case of relapse was found, and this patient underwent 2-drug therapy versus 3-drug therapy.


Conclusion: These data are remarkable for the absence of relapse with daily rifampin, as contrasted with the published experience using the WHO protocol with monthly rifampin.

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References

1. Scollard DM, Adams LB, Gillis TP, et al. The continuing challenges of leprosy. Clin Microbiol Rev 2006;19:338-381.
 
2. World Health Organization Study Group. Chemotherapy of Leprosy for Control Programmes. World Health Organization. Technical Report Series no. 675. Geneva, Switzerland, World Health Organization, 1982.
 
3. World Health Organization. Report on the Third Meeting of the WHO Technical Advisory Group on Elimination of Leprosy. WHO/CDS/CPE/CEE/2002.29. Geneva, Switzerland, World Health Organization, 2002.
 
4. World Health Assembly. Elimination of Leprosy: Resolution of the 44th World Health Assembly. Resolution No. WHA 44.9. Geneva, Switzerland, World Health Organization, 1991.
 
5. Cellona RV, Balagon MF, dela Cruz EC, et al. Long-term efficacy of 2-year WHO multiple-drug therapy (MDT) in multibacillary (MB) leprosy patients. Int J Lepr Other Mycobact Dis 2003;71:308-319.
 
6. Subcommittee on Clinical Trials of the Chemotherapy of Leprosy (THELEP). Scientific working group of the UNDP/World Bank/WHO special program for research and training in tropical diseases. Lepr Rev 1987;58:325-327.
 
7. Leprosy beyond the year 2000 [editorial]. Lancet 1997;350:1717.
 
8. Dasanjali K, Schreuder PA, Pirayavaraporn CA. Study on the effectiveness and safety of the WHO/MDT regimen in the northeast of Thailand; a prospective study, 1984-1996. Int J Lepr Other Mycobact Dis 1997;65:28-36.
 
9. Ji B. Why multidrug therapy for multibacillary leprosy can be shortened to 12 months. Lepr Rev1998;69:106-109.
 
10. Shen J, Liu M, Zhang J, et al. Relapse in MB leprosy patients treated with 24 months of MDT in south west China: a short report. Lepr Rev 2006;77:219-224.
 
11. Shaw IN, Natrajan MM, Rao GS, et al. Long-term follow-up of multibacillary leprosy patients with high BI treated with WHO/MDT regimen for a fixed duration of two years. Int J Lepr Other Mycobact Dis 2000;68:405-409.
 
12. Li HY, Hu LR, Wu PW, et al. Fixed-duration multidrug therapy in multibacillary leprosy. Int J Lepr Other Mycobact Dis 1997;65:230-237.
 
13. Li HY, Hu LF, Huang WB, et al. Risk of relapse in leprosy after fixed-duration multidrug therapy. Int J Lepr Other Mycobact Dis 1997;65:238-245.
 
14. Jesudasan K, Vijayakumaran P, Manimozhi N, et al. Effectiveness of MDT in multibacillary leprosy.Int J Lepr Other Mycobact Dis 1996;64:128-132.
 
15. Jesudasan K, Vijayakumaran P, Manimozhi N, et al. Absence of relapse within 4 years among 34 multibacillary patients with high BIs treated for 2 years with MDT. Int J Lepr Other Mycobact Dis 1996;64:133-135.
 
16. Chen XS, Li WZ, Jiang C, et al. Studies on risk of leprosy relapses in China: relapses after treatment with multidrug therapy. Int J Lepr Other Mycobact Dis 1999;67:379-387.
 
17. Baohong J. Does there exist a subgroup of MB patients at greater risk of relapse after MDT? Lepr Rev 2001;72:3-7.
 
18. Jamet P, Ji B. Relapses in multibacillary leprosy patients after stopping treatment with rifampin-containing combined regimens. Marchoux Chemotherapy Study Group. Int J Lepr Other Mycobact Dis 1992;60:525-535.
 
19. Balagon MV, Cellona RV, Fajardo TT Jr, et al. Detection of new leprosy cases at a walk-in skin clinic in Cebu City, Philippines, highlights surveillance. Int J Dermatol 1999;38:796-797.
 
20. Becx-Bleumink M. Relapses in leprosy patients after release from dapsone monotherapy; experience in the leprosy control program of the all Africa Leprosy and Rehabilitation Training Center (ALERT) in Ethiopia. Int J Lepr Other Mycobact Dis 1992;60:161-172.
 
21. Bryceson A, Pfaltzgraf RE. Leprosy. 3rd ed. Edinburgh, UK, Churchill Livingstone, 1990:134-176.
 
22. Dasananjali K. Relapse of leprosy after multidrug therapy. J Med Assoc Thai 1996;79:635-639.
 
23. Dela Cruz E, Cellona RV, Balagon MV, et al. Primary dapsone resistance in Cebu, The Philippines; cause for concern. Int J Lepr Other Mycobact Dis 1996;64:253-256.
 
24. World Health Organization. Risk of relapse in leprosy. The Leprosy Unit. Division of Tropical Diseases, 94.1. Geneva, Switzerland, World Health Organization, 1994.
 
25. Jamet P, Ji B. Relapse after long-term follow up of multibacillary patients treated by WHO multidrug regimen. Int J Lepr Other Mycobact Dis 1992;62:62.
 
26. Jamet P, Ji B. Relapse after long-term follow up of multibacillary patients treated by WHO multidrug regimen. Marchoux Chemotherapy Study Group. Int. J Lepr Other Mycobact Dis 1995;63:195-201.
 
27. Norman G, Joseph G, Richard J. Relapses in multibacillary patients treated with multi-drug therapy until smear negativity: findings after twenty years. Int J Lepr Other Mycobact Dis 2004;72:1-7.
 
28. Gelber RH, Balagon VF, Cellona RV. The relapse rate in MB leprosy patients treated with 2-years of WHO-MDT is not low. Int J Lepr Other Mycobact Dis 2004;72:493-500.
 
29. World Health Organization. Shortening duration of treatment of multibacillary leprosy. Wkly Epidemiol Rec 1997;72:125-132.
 
30. Health Resources and Services Administration. National Hansen's Disease Program Preparation and Examination of Skin Smears. 2008. Available at: http://www.hrsa.gov/hansens/clinical/diagnostics/prepexam.htm. Accessed September 14, 2009.
 
31. Fajardo TT, Villahermosa L, Pardillo FE, et al. A comparative clinical trial in multibacillary leprosy with long-term relapse rates of tour different multidrug regimens. Am J Trop Med Hyg 2001;81:330-334.
 
32. Shepard CC, Levy L, Fasal P. Rapid bacteriocidal effect of rifampicin on M. lepraeAm J Trop Med Hyg 1972;21:446-449.
 
33. Jamet P, Blanc L, Fayne OC, et al. Relapses after a single dose of rifampin in skin-smear negative multibacillary patients after dapsone monotherapy. Int J Lepr Other Mycobact Dis 1994;62:209-213.
 
34. Schreuder PA. The occurrence of reactions and impairments in leprosy: experience in the leprosy control program of three provinces in northeastern Thailand, 1987-1995 [correction of 1978-1995]. Overview of the study. Int J Lepr Other Mycobact Dis 1998;66:149-158.
 
35. Suite M. Relapse rates following leprosy multidrug therapy. West Indian Med J 2000;49:210-211.
 
36. Girdhar BK, Girdhar A, Kumar A. Relapses in multibacillary leprosy patients: effect of length of therapy. Lepr Rev 2001;71:144-153.
 
37. Gelber RH. Activity of minocycline in Mycobacterium leprae-infected mice. J Infect Dis 1987;156:236-239.
 
38. Suneetha S, Reddy R. Histological resolution and bacterial clearance with pulse ROM therapy in borderline lepromatous leprosy. Int J Lepr Other Mycobact Dis 2001;69:53-54.
 
39. Ji B. Relapse of multibacillary leprosy after treatment with daily rifampin plus ofloxacin for four weeks. Int J Lepr Other Mycobact Dis 1998;66:391-392.
 
40. World Health Organization. Leprosy: global target attained-remaining endemic countries pose greatest challenge [press release]. Geneva, Switzerland, World Health Organization, 2002.
 
41. Li HY, Ran SP, Weng XM, et al. Relapses in leprosy patients treated with rifampicin plus dapsone after varying periods of dapsone monotherapy. Indian J Lepr 2001;73:1-10.
 
42. Pattyn S, Grillone S. Relapse rates and a 10-year follow-up of a 6-week quadruple drug regimen for multibacillary leprosy. Lepr Rev 2001;73:245-247.