Multidrug Therapy Alone Lacks Efficacy in Treating Leprosy

Single medication regimens are not efficient enough to treat leprosy, multibacillary leprosy, or a type 2 leprosy reaction.

Combining the multidrug therapy (MDT) recommended by the World Health Organization (WHO) with other medications may be more efficacious than MDT alone, according to study findings published in Journal of Infection.

Researchers conducted a systematic review and meta-analysis using the EMBASE and PubMed databases from inception to October 2021 of controlled clinical trials (CTs) that compared efficacy or safety of anti-leprosy drugs and were evaluated by 2 independent reviewers.

All included cases were confirmed based on laboratory testing and clinical findings. Participants unable to complete therapy or attend follow-up were excluded as were CTs that recruited patients previously treated with any drugs. The researchers used P scores to measure the extent of certainty that a treatment is better than others from 0 (worst) to 1 (best).

A total of 60 studies that comprised 9256 participants were included in the final analysis. The CTs compared efficacy and safety of 41 regimens and medications that concluded MDT was efficacious for treating leprosy and multibacillary leprosy (odds ratio [OR] range, 1.06-1,255,584.25).

The WHO MDT could still be used for treating leprosy and multibacillary leprosy, but the efficacy may not be good enough.

It was observed that 6 treatments were more efficacious than MDT alone (OR range, 1.199-4.50; MDT+pefloxacin [P score, 0.9328], ofloxacin [P score, .09245], dapsone+clofazimine+ofloxacin [P score, .08963], MDT+acedapsone [P score, .08751], MDT+prednisolone [P score, .08376], MDT+ofloxacin [P score, .08221]).

The efficacy of MDT plus other medications for treating multibacillary leprosy (MDT+pefloxacin [P score, .08669], ofloxacin [P score, .08184], MDT {+} [P score, .08074], MDT+acedapsone [P score, .07967]) was ranked significantly more effective than other regimens.

Treatment of type 2 leprosy reaction was effective with clofazimine (P score, .09141) and dapsone plus rifampicin (P score, .08785).

There were no significant differences in the safety of all the study medications.

Of the 10 most efficacious regimens for treating leprosy, the researchers noted 8 contained MDT. Prednisolone, acedapsone, ofloxacin, and pefloxacin were found to augment MDT efficacy.

Limitations of the study include a lack of high-quality data, lacking data on drug treatments for type 1 leprosy and paucibacillary reactions, and an underpowered sample size for some medications.

Researchers conclude, “The WHO MDT could still be used for treating leprosy and multibacillary leprosy, but the efficacy may not be good enough.”

This article originally appeared on Dermatology Advisor


Yang J, Kong J, Li B, et al. Seventy years of evidence on the efficacy and safety of drugs for treating leprosy: a network meta-analysis. J Infect. Published online February 14, 2023. doi:10.1016/j.jinf.2023.02.019