title: Is there a role for rifampicin, ofloxacin and minocycline (ROM) therapy in the treatment of leprosy? Systematic review and meta-analysis.
abstract: BACKGROUND
  A combination of rifampicin, ofloxacin and minocycline (ROM) is one of the newer recommendations for treatment of leprosy. We performed a systematic review and a meta-analysis of studies that had evaluated the efficacy of ROM therapy in treatment of paucibacillary and multibacillary leprosy patients.
  
  
  METHODS
  Studies were identified by searching the PubMed, Embase, LILACS and Cochrane databases. Data were abstracted from all relevant studies, and fixed effects models were used to calculate the summary estimate of effect in paucibacillary and multibacillary leprosy patients.
  
  
  RESULTS
  Six studies comparing ROM therapy to multidrug therapy and eight studies that evaluated the effect of ROM therapy alone (no comparison group) were included in the review and meta-analysis. The combined estimate for single dose ROM vs. multidrug therapy in paucibacillary leprosy patients suggested that ROM was less effective than multidrug therapy in these patients [relative risk: 0.91, 95% confidence intervals (CI): 0.86-0.97]. However, the combined estimate for multiple doses of ROM vs. multidrug therapy in multibacillary leprosy patients suggested that ROM was as effective as multidrug therapy in reducing bacillary indices in these patients (proportion change: -4%, 95% CI -31% to 23%). No major side effects were reported in either the ROM or the multidrug treatment groups.
  
  
  CONCLUSIONS
  Single-dose ROM therapy was less effective than multidrug therapy in paucibacillary patients. However, there are insufficient data to come to a valid conclusion on the efficacy of multidose ROM therapy in multibacillary leprosy, and additional studies with ROM therapy in multibacillary leprosy are needed. Furthermore, multiple doses may be considered as another alternative even for paucibacillary patients, and randomised controlled trials of this therapy may be useful to understand its contribution in the treatment and control of leprosy.
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Maninder S
authors.initials: MS
authors.lastname: Setia
authors.forename: Santosh S
authors.initials: SS
authors.lastname: Shinde
authors.forename: Hemangi R
authors.initials: HR
authors.lastname: Jerajani
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Boivin
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D007917:Leprostatic Agents / Q000008:administration & dosage; D007918:Leprosy / Q000188:drug therapy*; D008911:Minocycline / Q000008:administration & dosage*; D015242:Ofloxacin / Q000008:administration & dosage*; D012293:Rifampin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D007917:Leprostatic Agents; D015242:Ofloxacin; D008911:Minocycline; D012293:Rifampin