Fixed duration MDT in paucibacillary leprosy.

The World Health Organization (WHO) has recommended a fixed duration of multidrug therapy (MDT) for paucibacillary leprosy which is currently widely implemented in India. A clinico-pathological study was initiated in 1984 to assess the efficacy of this regimen. The clinical and histological responses of the patients to MDT were assessed at the end of 6 months, when their treatment was stopped, and at 2 1/2 years, when they were released from surveillance, and compared with the responses of a matched patient group to conventional dapsone (DDS) monotherapy during the same period. Of 28 patients who completed the MDT schedule, there was less than 60% improvement in 33% of them when treatment was stopped at the end of 6 months and in 20% of them at the end of 2 1/2 years. Of 26 patients receiving DDS monotherapy, 37% showed less than 60% improvement at the end of 6 months but only 8.8% had less than 60% improvement at 2 1/2 years. It is concluded that MDT for paucibacillary leprosy as recommended by WHO may not have a major advantage over DDS monotherapy, since about 20% of those patients on MDT continue to have evidence of active disease when discharged from surveillance.