Kumar Anil, Girdhar Anita, Chakma Joy Kumar, Girdhar Bhuwneswar Kumar
National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India.
Biomed Res Int. 2015;2015:705804. doi: 10.1155/2015/705804. Epub 2015 Feb 1.
To study the magnitude of default, time of default, its causes, and final clinical outcome.
Data collected in active surveys in Agra is analyzed. Patients were given treatment after medical confirmation and were followed up. The treatment default and other clinical outcomes were recorded.
Patients who defaulted have comparable demographic characteristics. However, among defaulters more women (62.7% in PB, 42.6% in MB) were seen than those in treatment completers (PB 52.7% and MB 35.9%). Nerve involvement was high in treatment completers: 45.7% in PB and 91.3% in MB leprosy. Overall default rate was lower (14.8%) in ROM than (28.8%) in standard MDT for PB leprosy (χ 1 (2) = 11.6, P = 0.001) and also for MB leprosy: 9.1% in ROM compared to 34.5% in MDT (χ 1 (2) = 6.0, P = 0.015). Default rate was not different (28.8% versus 34.5%, P > 0.05) in both types of leprosy given MDT. Most patients defaulted at early stage of treatment and mainly due to manageable side effects.
The default in standard MDT both for PB and MB leprosy was observed to be significantly higher than in ROM treatment. Most defaults occurred at early stage of treatment and major contribution of default is due to side effects like drowsiness, weakness, vomiting, diarrhea, and so forth, related to poor general health. Although about half of the defaulters were observed to be cured 2.2% in PB-MDT and 10.9% of MB-MDT developed disability. This is an issue due to default. Attempts are needed to increase treatment compliance. The use of specially designed disease related health education along with easily administered drug regimens may help to reduce default.
研究违约率、违约时间、其原因以及最终临床结局。
对在阿格拉进行的主动调查收集的数据进行分析。患者经医学确认后接受治疗并进行随访。记录治疗违约情况及其他临床结局。
违约患者具有可比的人口统计学特征。然而，在违约者中，女性比例高于完成治疗者（PB组中女性占62.7%，MB组中占42.6%，而完成治疗者中PB组为52.7%，MB组为35.9%）。完成治疗者的神经受累情况较为严重：PB型麻风病中为45.7%，MB型麻风病中为91.3%。PB型麻风病中，ROM治疗的总体违约率（14.8%）低于标准多药联合化疗（MDT）（28.8%）（χ²(1,2)=11.6，P = 0.001），MB型麻风病也是如此：ROM治疗中为9.1%，MDT中为34.5%（χ²(1,2)=6.0，P = 0.015）。在接受MDT治疗的两种类型麻风病中，违约率没有差异（28.8%对34.5%，P>0.05）。大多数患者在治疗早期违约，主要原因是可控制的副作用。
观察发现，PB型和MB型麻风病的标准MDT违约率显著高于ROM治疗。大多数违约发生在治疗早期，违约的主要原因是与总体健康状况不佳相关的副作用，如嗜睡、虚弱、呕吐、腹泻等。尽管约一半的违约者被观察到已治愈（PB - MDT组为2.2%，MB - MDT组为10.9%）出现了残疾。这是违约导致的一个问题。需要努力提高治疗依从性。使用专门设计的与疾病相关的健康教育以及易于管理的药物治疗方案可能有助于减少违约。
