Recent Advances in Leprosy Chemotherapy

Abstract

Abstract

This study reviews the status and data for recent advances in leprosy chemotherapy since the WHO study group on chemotherapy of leprosy for control programs recommended multi-drug therapy (MDT) regimens in 1981, which were widely implemented globally. The implementation of MDT resulted in a dramatic decline in prevalence, leading the World Health Assembly in 1991 to set the goal of eliminating leprosy as a public health problem (reducing prevalence to below 1 per 10,000 population) by 2000. Although progress towards this goal has been excellent, it is now appropriate to review the chemotherapy of leprosy in the light of 25 years’ experiences, and with the recent introduction of several new bactericidal anti-leprosy drug regimens. The latter were reviewed from the first alternative official regimens of WHO/MDT such as the new recommendation that the duration of the current MDT regimen for multibacillary leprosy (MB) could be further shortened from 24 to 12 months. The second alternative official regimen was a single dose of ROM (combination of rifampicin, ofloxacin and mynocycline) for a single-lesion paucibacillary leprosy (PB), the first fully supervisable, monthly-administered regimen. Furthermore, the common treatment of MB and PB by multiple monthly dose of ROM has been tested in the field trials. Another field trial was a combination of rifampicin-moxifloxacin and mynocycline (RMM) which was far more bactericidal than ROM. The fifth WHO-recommended regimen was that all leprosy patients, both PB and MB, were treated by the common MDT for MB leprosy for a period of only six months. The magnitude of MB relapse after MDT, and the possible existence of a higher risk subgroup of MB leprosy, together with the need for both flexible and reliable MDT treatments and drugs are reviewed and discussed with recommendations.

Keywords: recent advances; chemotherapy; leprosy