Title : Innovative bactericidal drugs pulse regimens for treatment of leprosy – Advancing towards zero leprosy

Abstract:

WHO recommended multi-drug therapy (MDT) in leprosy has proven effective; BUT challenges like treatment adherence, drug resistance, dapsone/ clofazimine bacteriostatic actions/side effects persist. Grosset et al ⁽¹⁾ suggested that PMM regimen consisting of Rifapentine, Minocycline and Moxifloxacin would be the most superior supervised pulse drug regimen.  In the past researchers using Rifampicin, Ofloxacin and Minocycline (ROM) as an alternative to WHO MDT with good success, have demonstrated comparable efficacy to standard MDT, with the added benefit of reduced adverse effects ⁽²⁾. WHO expert committee of Leprosy, seventh report also suggested ROM 24 months’ regimen for those who do not accept Clofazimine pigmentation. ⁽³⁾.  RMM (Rifampicin, Minocycline and Moxifloxacin), have demonstrated greater efficacy and lesser side effects than conventional treatments. ⁽⁴⁾ RCM (Rifampicin, Clarithromycin and Minocycline) ongoing trial regimen in our centre shows positive outcome both clinically as well as bacteriologically.  However, higher incidence of Type 2 Leprosy reaction has been observed as compared to WHO MDT regimen.

Brodiquiline is another potential bactericidal found very effective, made all viable bacilli dead in four weeks monotherapy regimen, this drug needs to be explored in monthly pulse regimen ⁽⁵⁾. RMM trial ⁽⁶⁾ done in USA showed successful treatment and remission of Hansen in 10 treated patients. All will be discussed in this talk.