Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012

Abstract

A simplified treatment in a single schema and shorter, rifampicin, dapsone and clofazimine for six months - UMDT for leprosy is being developed in Brazil to evaluate its effectiveness. Even if you will observe a recurrence percentage acceptable in terms of public health, with a good acceptance of treatment, the frequency of reactions is also an evaluator of the effectiveness of the scheme introduced. This study aims to characterize the pattern of occurrence and determinants of leprosy reactional episodes in patients treated with UMDT versus those treated with RMDT, regular treatment established by WHO / MS-BR in two reference centers for leprosy in Brazil in the period up to five years after discharge. This is an intervention study used to compare the reaction episodes between the two treatment groups. We evaluated 858 patients recruited between March 2007 and April 2012, of which 417 (48.6%) had reactions during the observation period. Patients were studied in separate clinical classification for its operating, paucibacillary (PB) or multibacillary (MB). The frequency of reaction time was analyzed using the survival function of the Kaplan-Meier method comparing the two study groups. The statistical test used was the log rank test. The multivariate modeling took into account the collected variables that could influence the occurrence of the reaction. There was no difference between treatment groups with regard to the occurrence of reactions for both PB, during the entire period of observation, and for the MB, from one year after six months of treatment. For MB, the UMDT patients have a higher risk of having reaction after stopping treatment. This risk tends to decrease when the RMDT patient end treatment at 12 months, and disappears after a year and a half of the beginning of the treatment of the two groups. If MB patients have had neuritis at enrollment, those who used the scheme UMDT had higher risk to present new reaction in the observed period than those who used the RMDT. Besides this difference, the present study showed a clear relationship between the R&J clinical form with the frequency of reactive episodes. Patients near the pole lepromatous, largest IB, showed more reaction. The BL forms are that more related to higher frequency of reactions. The results based on the occurrence of reactions allow recommendation of reducing regimen, proposing a single scheme with duration of 6 months for all patients diagnosed with leprosy, but with the recommendation of a special attention in those patients who begin treatment already presenting neuritis signals.