Effectiveness of MDT in MB

Leprosy: a long term follow up

Study done at : SLR and TC

Karigiri, India

Published in: Leprosy Review

June 2003

Chief Guide

Shahab Uddin Ahmed Chowdhury

Associate Professor of Dermatology

MMC

Presented by

Dr Pankaj Kumar Das

Student of DDV

MMC

SummarySummaryField trials started in December 1981Field trials started in December 1981

Treatment Regimens:Treatment Regimens:

Regimen – A Regimen – A

RMP – 600 mg, supervised, 2 RMP – 600 mg, supervised, 2 days/monthdays/month

Clof – 300 mg, supervised, 2 Clof – 300 mg, supervised, 2 days/monthdays/month

Inj Acedapsone – 225 mg, Inj Acedapsone – 225 mg, bimonthlybimonthly

&&

Dapsone 100 mg dailyDapsone 100 mg daily

Contd…..Contd…..Regimen – BRegimen – B

( Conventional WHO regimen )( Conventional WHO regimen )RMP – 600 mg, once monthly supervisedRMP – 600 mg, once monthly supervisedClof – 300 mg, once monthly supervisedClof – 300 mg, once monthly supervisedDDS – 100 mg dailyDDS – 100 mg dailyClof – 50 mg dailyClof – 50 mg daily

Contd…..Contd…..

Duration of Treatment:Duration of Treatment:Minimum 2 years Minimum 2 years

or or

Until skin smear negativity, Until skin smear negativity,

which ever occurs laterwhich ever occurs later

Contd….Contd….Study PopulationStudy Population

Total 1067 cases, Total 1067 cases, Completed treatment 980Completed treatment 980 Follow up could be done 723Follow up could be done 723 Newly detected, previously Newly detected, previously

untreated cases – 44untreated cases – 44 Long term follow up could be done Long term follow up could be done

in 34 cases in 34 cases Mean FU period – 13.7 Mean FU period – 13.7 ±± 1.4 years 1.4 years

per patientper patient

Contd…Contd…No Relapse seenNo Relapse seenBoth Regimens were well Both Regimens were well toleratedtolerated

IntroductionIntroduction

1982 WHO introduced MDT1982 WHO introduced MDT 1993 WHO recommended FDT1993 WHO recommended FDT Relapse rate – less than 1% (data Relapse rate – less than 1% (data

from LCPS) in MB patientfrom LCPS) in MB patient Study done: To clarify the risk of Study done: To clarify the risk of

relapserelapse

Material & MethodsMaterial & Methods

Patients registered for treatment – Patients registered for treatment – Dec 1981 – Dec 1982Dec 1981 – Dec 1982

Duration of treatment – 2 years or Duration of treatment – 2 years or until negativity, which ever is lateruntil negativity, which ever is later

Duration of follow up: till 1999 (17 Duration of follow up: till 1999 (17 yrs)yrs)

Number of Patients: Number of Patients: Started treatment – 1067Started treatment – 1067 Completed treatment – 980Completed treatment – 980 Completed follow up - 723Completed follow up - 723

Contd…..Contd…..

Fresh Patients:Fresh Patients: Started MDT – 44Started MDT – 44 Completed – 44Completed – 44Died – 3, Migrated – 7Died – 3, Migrated – 7 Completed follow up – 34Completed follow up – 34

Regimen = A – 16Regimen = A – 16

Regimen = B – 18Regimen = B – 18

Contd….Contd….Follow up DetailsFollow up Details

Frequency of FUFrequency of FU Treatment Period – monthlyTreatment Period – monthly After RFT After RFT

up to 5 years – quarterlyup to 5 years – quarterly Then, annually with detailed clinical Then, annually with detailed clinical

& bacteriological assessment& bacteriological assessment

Contd…..Contd…..Follow Up ToolsFollow Up Tools

ClinicalClinical BacteriologicalBacteriological Tablet countTablet count Urinary Dapsone Urinary Dapsone

Creatinine ratioCreatinine ratio

ResultsResults BI decreases by 0.5 to 1+ per yearBI decreases by 0.5 to 1+ per year

No significant difference in bacilli No significant difference in bacilli clearance by both regimensclearance by both regimens

No adverse effect except clof. No adverse effect except clof. DiscolorationDiscoloration

No relapseNo relapse

Need prolonged FU to justify MDT relapseNeed prolonged FU to justify MDT relapse

Two survey by WHO in early 1990sTwo survey by WHO in early 1990s

Relapse rate – 0.23% (92, 194)Relapse rate – 0.23% (92, 194)

Relapse rate – 0.77% (1414)Relapse rate – 0.77% (1414)

Study in India – no relapse (261 MB, 6 Yrs Study in India – no relapse (261 MB, 6 Yrs FU)FU)

ALERT study – No relapse (256 MB, 4.3 yrs ALERT study – No relapse (256 MB, 4.3 yrs FU)FU)

DISCUSSION

ConclusionConclusion

Treatment with MDT:Treatment with MDT:SafeSafe

Well toleratedWell toleratedWell accepted Well accepted

Very effective in Very effective in preventing preventing

relapserelapse

AcknowledgementAcknowledgement

Professor Shah Abdul LatifProfessor Shah Abdul Latif

Dr M Akram HossainDr M Akram Hossain

Mr M Lutfur RahmanMr M Lutfur Rahman

Mr Sultan Uddin AhmedMr Sultan Uddin Ahmed

Mymensingh Medical College Hospital

Bangladesh.