Current Leprosy Multi-Drug Treatment Duration for MB Patients (12 Months) Produces Good Clinical Outcomes over Many Years

There have been recent discussions in the leprosy world by people concerned that the current 12 months multi-drug treatment (MDT) regimens for multibacillary leprosy patients are inadequate and contribute to poor control of the disease.We argue here that recent studies show that the current regimens are good for treating the infection in individual patients and do not need extending.Patients with an initial high BI do not need longer treatments. 1,2Clinicians and patients should have a long time frame for patient improvement which can be years after treatment has finished.The WHO sponsored multi-drug regimens were introduced in 1982 and have been regularly altered since then. 3,4Initially patients with MB leprosy were treated until their slit skin smears were negative.In 1994 the WHO Expert Committee recommended fixed duration treatment of 24 months for MB patients.This was reduced to 12 months in 1998. 5,6These decisions were not supported by data from prospective drug trials.Fortunately, the relapse rate in leprosy has been very low, with about 1% of patients relapsing with a new study from Brazil showing a low relapse rate after treatment with 12 months MDT with a 12 year follow up. 1,7,8An early study in Ethiopia had a zero relapse rate after 24 months treatment. 9Patient outcomes after leprosy multi-drug treatment can be assessed by three measures: (1) Clinical improvement of the lesions, (2) Fall in the Bacterial Index and (3) relapse rate.Clinical improvement of skin lesions is variable.This is partly due to the ongoing inflammation in the lesions which is part of the clinical disease.Some patients' skin lesions resolve