title: Long-term efficacy of 2 year WHO multiple drug therapy (MDT) in multibacillary (MB) leprosy patients.
abstract: Relapse rate estimates after 2 year WHO multiple drug therapy (MDT) in multi-bacillary (MB) leprosy vary. Between 1987 and 1994, 500 MB leprosy patients completing 2 year MDT were enrolled in a prospective relapse study. The majority of patients (N = 316) were treated and followed at the physician-staffed Cebu Skin Clinic (CSC), whereas others (N = 184) received therapy from government clinics and were followed by CSC technicians in the field. Relapse definition was an increased bacteriologic index (BI) and new skin lesions, supplemented with mouse footpad inoculations. Through 2002, follow-up was 5368 person-years, with a mean of 10.8 years per patient. The absolute relapse rate was 3% (15/498; 0.28/100 person-years), with a cumulative risk estimate of 3.9% at 15 yrs. For a subset of 217 patients followed for >or=12 yrs or until relapse, relapses occurred in 9% (13/142) attending the CSC, versus 3% (2/75) assessed in the field (p = 0.09). The rate for patients followed at CSC for >or=12 yrs and a pre-treatment BI >or=2.7+ was 13% (13/98). All relapses were BL or LL, with pre-treatment BI's of >or=2.7+. Relapses occurred long after completion of therapy, between 3 and 11 yrs from the midpoint of the examination without relapse to detection, or between 6 to 13 yrs to the actual year of detection, 7 occurring at >or=10 yrs. Lesion material from all relapses contained M. leprae that was rifampin and clofazimine sensitive, whereas 3 showed partial or full dapsone resistance. [Follow-up rigor and time], medical expertise, and pre-treatment bacterial load influence relapse rates after 2 yr MDT.
authors.affiliation: Leonard Wood Memorial Center for Leprosy Research, Cebu City, Philippines.
authors.forename: Roland V
authors.initials: RV
authors.lastname: Cellona
authors.forename: Maria F V
authors.initials: MF
authors.lastname: Balagon
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: dela Cruz
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Burgos
authors.forename: Rodolfo M
authors.initials: RM
authors.lastname: Abalos
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Walsh
authors.forename: Richard
authors.initials: R
authors.lastname: Topolski
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gelber
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007917:Leprostatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007918:Leprosy / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D051379:Mice; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000187:drug effects; D010679:Philippines; D012008:Recurrence; D013997:Time Factors; D014944:World Health Organization
chemical_list: D007917:Leprostatic Agents