Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States.
Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States.
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DOI：
10.1177/20499361221135885
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发表时间：
2022-01
影响因子：
5.7
通讯作者：
Stryjewska, Barbara
中科院分区：
文献类型：
--
作者：
Franco-Paredes, Carlos;Garcia-Creighton, Elizabeth;Henao-Martinez, Andres;Kallgren, Diane L.;Banjade, Rashmi;Dyer, Jon A.;Nelson, Taylor;Zaesim, Araya;Peluso, Michael J.;Jain, Vivek;Lee, Dong Heun;Minces, Lucio R.;Wirshup, Mary;Sierra Hoffman, Miguel;Katsolis, Jenn;Brust, Karen;Giron, Jose;Smiarowski, Lauren;Hoosepian-Mer, Pauline A.;Stryjewska, Barbara
世界卫生组织（WHO）建议采用多药疗法（MDT）治疗少菌型和多菌型麻风病，也称为汉森病（HD）。氨苯砜、利福平和氯法齐明的MDT组合降低了疾病的患病率，但并非没有影响方案依从性的不良反应。因此，迫切需要考虑具有改善的安全性特征的替代MDT方案，以促进治疗依从性。在此，我们描述了一个病例系列的10例HD患者（9例多菌型麻风和1例纯神经型麻风），每月接受利福平，氟沙星和米诺环素（RMM）治疗。美国国家汉森疾病计划（NHDP）诊断和治疗美国机构的患者。所有患者均接受12-24个月的RMM治疗方案。我们回顾了2019年1月至2022年8月每月接受RMM治疗的患者的临床结局、依从性、完成率和不良事件。9例患者为多菌型麻风，其中一些患者有2型反应。1例为单纯神经性麻风伴逆转反应。在该病例系列中，我们发现所有患者均完成了RMM方案，未中断治疗。所有患者均未出现任何皮肤色素沉着或任何显著副作用。所有患者均耐受每月一次的RMM方案，皮肤病变迅速改善，无逻辑障碍。根据以往的临床证据和本病例系列的结果，NHDP和其他项目应考虑将RMM方案作为一线治疗。
The World Health Organization (WHO) recommends multidrug therapy (MDT) for the treatment of paucibacillary and multibacillary forms of leprosy, also known as Hansen’s disease (HD). MDT combinations of dapsone, rifampin, and clofazimine have reduced the prevalence of the disease but are not without adverse effects impacting regimen adherence. Hence, an urgent need exists to consider alternative MDT regimens with an improved safety profile that promotes treatment adherence. Herein, we described a case series of 10 patients with HD (nine patients with multibacillary leprosy and one with pure neural leprosy) treated with monthly rifampin, moxifloxacin, and minocycline (RMM). The United States National Hansen’s Disease Program (NHDP) diagnosed and treated patients across US institutions. All patients received a regimen of 12–24 months of RMM. We reviewed the clinical outcomes, adherence, rate of completion, and adverse events of patients treated with monthly RMM from January 2019 to August 2022. Nine patients had multibacillary leprosy, with some having type-2 reactions. One patient had pure neural leprosy with a reversal reaction. In this case series, we identified that all patients completed the RMM regimen without treatment interruptions. None of the patients experienced any skin hyperpigmentation or any significant side effects. All patients tolerated the monthly RMM regimen with rapid improvement of skin lesions and without logistic hurdles. Based on previous clinical evidence and the results of this case series, the NHDP and other programs should consider the RMM regimen as first-line therapy.
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