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

BACKGROUND

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 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.

OBJECTIVES

To estimate the 10 years relapse rate of MB patients treated with 6 months U-MDT.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00669643.

Factors affecting treatment adherence among leprosy patients: Perceptions of healthcare providers

Background

Treatment adherence is a vital aspect in the management of chronic diseases like leprosy; however, most studies on treatment adherence focus on patients. This study aims to examine the perceptions of healthcare providers on factors that can promote or prevent patients from adhering to treatment.

Methods

We conducted three focus group discussions (FGDs) with healthcare providers who have at least one year experience in managing leprosy in three large leprosy case-holding hospitals in Metro Manila, Philippines. We audio-recorded, transcribed, translated the FGD proceedings, and analyzed the transcripts thematically to identify patient-intrinsic and patient-extrinsic enablers and barriers to treatment adherence of leprosy patients.

Results

Patient-intrinsic motivators to complete treatment include innate desire to be cured, fear of infecting family and friends, fear of disability, good knowledge about the disease, need for medical clearance to be considered fit to work, and experiencing leprosy reactions. Patient-extrinsic motivators to complete treatment include free treatment, immediate and sufficient counselling, flexibility in treatment, follow-up and motivation of healthcare workers, and presence of Hansen's Club and support groups. Patient-intrinsic barriers to good treatment adherence include distance between residence and hospital, financial and opportunity costs, adverse drug reactions, misconceptions about being cured, disabilities and presence of leprosy reactions, stubbornness and/or laziness, and undergoing clinical depression. Patient-extrinsic barriers to good treatment adherence include poor availability of MDT, transfer to other leprosy treatment facilities without informing current facility, and stigma.

Conclusion

Healthcare providers perceive that patient-intrinsic and patient-extrinsic factors influence the treatment adherence of leprosy patients through different mechanisms. We highlight the role of healthcare provider attitudes, stigma, and support groups in promoting treatment adherence.

Comparison of sarcopenic status between elderly leprosy survivors and general population

Because of chronicity and poor environments, elderly leprosy survivors might be at greater risk of developing obesity and sarcopenia than healthy individuals. This study aimed to investigate whether body composition and the prevalence of obesity and sarcopenia among elderly leprosy survivors with no or mild physical impairment differ from those of the general population. A total of 36 leprosy survivors aged 65-90 years with no or mild physical impairment were recruited. Individuals matched for sex, age, and height were selected as a control group from the Fourth Korea National Health and Nutrition Examination Survey. Anthropometric characteristics, body composition, appendicular skeletal muscle mass (ASM), modified skeletal muscle mass index (SMI), and the prevalence of obesity and sarcopenia were compared between the leprosy survivors and the control group. Compared to the control group, the leprosy survivors had higher body weight, BMI, total fat mass, and total fat percentage. The leprosy survivor group also had lower ASM (P=0.035) and SMI (P<0.001) values. Comparison of the composition of regional body parts showed that the lean body mass of the legs was lower in the leprosy survivor group even though this group had higher body weight. The leprosy survivor group also had a significantly higher prevalence of sarcopenia than the control group (38.7% vs. 5.6%; P=0.002). These findings suggest that leprosy survivors are at greater risk of developing obesity and sarcopenia than healthy individuals. Further researches are required to investigate causes and mechanisms of sarcopenia in leprosy survivors.