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

Summary Field trials started in December 1981 Treatment Regimens: Regimen – A RMP – 600 mg, supervised, 2 days/month Clof – 300 mg, supervised, 2 days/month Inj Acedapsone – 225 mg, bimonthly & Dapsone 100 mg daily

Contd….. Regimen – B ( Conventional WHO regimen ) RMP – 600 mg, once monthly supervised Clof – 300 mg, once monthly supervised DDS – 100 mg daily Clof – 50 mg daily

Contd….. Duration of Treatment: Minimum 2 years or or Until skin smear negativity, which ever occurs later

Contd…. Study Population  Total 1067 cases,  Completed treatment 980  Follow up could be done 723  Newly detected, previously untreated cases – 44  Long term follow up could be done in 34 cases  Mean FU period – 13.7 ± 1.4 years per patient

Contd… No Relapse seen No Relapse seen Both Regimens were well tolerated Both Regimens were well tolerated

Introduction  1982 WHO introduced MDT  1993 WHO recommended FDT  Relapse rate – less than 1% (data from LCPS) in MB patient  Study done: To clarify the risk of relapse

Material & Methods Patients registered for treatment – Dec 1981 – Dec 1982 Patients registered for treatment – Dec 1981 – Dec 1982 Duration of treatment – 2 years or until negativity, which ever is later Duration of treatment – 2 years or until negativity, which ever is later Duration of follow up: till 1999 (17 yrs) Duration of follow up: till 1999 (17 yrs) Number of Patients: Number of Patients: Started treatment – 1067 Started treatment – 1067 Completed treatment – 980 Completed treatment – 980 Completed follow up Completed follow up - 723

Contd….. Fresh Patients: Started MDT – 44 Started MDT – 44 Completed – 44 Completed – 44  Died – 3, Migrated – 7 Completed follow up – 34 Completed follow up – 34 Regimen = A – 16 Regimen = B – 18

Contd…. Follow up Details Frequency of FU Frequency of FU Treatment Period – monthly Treatment Period – monthly After RFT After RFT up to 5 years – quarterly up to 5 years – quarterly Then, annually with detailed clinical & bacteriological assessment Then, annually with detailed clinical & bacteriological assessment

Contd….. Follow Up Tools Clinical Clinical Bacteriological Bacteriological Tablet count Tablet count Urinary Dapsone Creatinine ratio Urinary Dapsone Creatinine ratio

Results BI decreases by 0.5 to 1+ per year BI decreases by 0.5 to 1+ per year No significant difference in bacilli clearance by both regimens No significant difference in bacilli clearance by both regimens No adverse effect except clof. Discoloration No adverse effect except clof. Discoloration No relapse No relapse

Need prolonged FU to justify MDT relapse Two survey by WHO in early 1990s Relapse rate – 0.23% (92, 194) Relapse rate – 0.77% (1414) Study in India – no relapse (261 MB, 6 Yrs FU) ALERT study – No relapse (256 MB, 4.3 yrs FU) DISCUSSION

Conclusion Treatment with MDT: Safe Well tolerated Well accepted Very effective in preventing relapse

Acknowledgement Professor Shah Abdul Latif Professor Shah Abdul Latif Dr M Akram Hossain Dr M Akram Hossain Mr M Lutfur Rahman Mr M Lutfur Rahman Mr Sultan Uddin Ahmed Mr Sultan Uddin Ahmed

Mymensingh Medical College Hospital Bangladesh.