It is essential to look to U-MDT (Uniform Multidrug Therapy) through the patients’ eyes. The question should be, is there strong scientific evidence to justify shortening the almost 40 year old standard antibiotic treatment regimen period for leprosy?
In a meeting on April 18th, 2018, at the Ministry of Health headquarters, the Brazilian Technical Advisory Board (CTA) of leprosy was informed that U-MDT would be implemented in Brazil with the same antibiotics used for almost 40 years, but with half of the minimal time used now for treating multibacillary (MB) patients, and with the same antibiotics for all patients, meaning that even paucibacillary (PB) patients, currently in Brazil around 30% of all patients, would have to use rifampicin, dapsone and clofazimine, which are usually only used for MB patients.
The reasons for this change are based on a single work published in PLoS Neglected Tropical Diseases, that would support the change for the treatment regimen. Before this meeting that was held on April, 18th, and already with the knowledge that the theme of the meeting would be U-MDT, The Brazilian Leprosy Society (SBH) published a public letter to CTA and to the Brazilian society in general, specifically to the doctors who treat thousands of cases every year in Brazil.
Despite this open letter against U-MDT, together with the opposition of 4 out of the 6 national leprosy reference centers that were represented at the meeting, there is no signal at all from the Ministry of Health to suspend the implementation of U-MDT for even a minimal discussion with stakeholders, neither patients nor the different entities that represent health professionals and scientists of this country.
Therefore, the different societies and associations signing this document, based on the following points, request to the Ministry of Health to suspend any proposal of implementation of U-MDT at this moment, and to make available resources to 1) intensify leprosy training to health professionals working at family health strategies all over Brazil; 2) support active surveillance of new cases of leprosy; 3) increase the quantity and quality of contact examination in Brazil; 4) determine the true percentage of cases with antibiotic resistance and; 5) make available new drugs for alternative drug regimens for patients with drug resistant strains or those that who do not respond well to the regular MDT used for the present treatment of leprosy. Stamp out the present troubling situation of drug resistance in the percentage of M. leprae strains on the planet (1).
The following are reasons why we believe it is irresponsible to implement U-MDT at this time:
We believe, in addition, that it is important to cite a recent document released by WHO where it is possible to interpret that “Evidence on the potential benefits and harms of a shorter (6-month) 3-drug regimen was limited and inconclusive, with a potential increase in the risk of relapse. Therefore, the GDG determined that there was not enough evidence of equivalent outcomes to support a recommendation to shorten the treatment duration for MB leprosy”, a obviously clear position against U-MDT implementation.
It is clear to us that the present data is insufficient and, thus, there are many reasons against implementing this U-MDT regimen.
Therefore, the Brazilian Leprosy Society (SBH) and all the entities signed below, the Brazilian Society of Infection (SBI), the Brazilian Medical Association (AMB), and the representatives of the Brazilian Association of Collective Health (ABRASCO), the National Counselor of Municipal Health Secretaries (CONASEMS), the National Reference Center at Uberlândia, Minas Gerais (CREDESH), and the National Reference Center at Ribeirão Preto, São Paulo, state publicly in this manifesto that there are insufficient data to support the implementation for the short regimen proposed of 6 doses of MDT, named U-MDT. We also want to emphasize the compelling need for increased training of basic health network personnel, aiming to increase the detection of hidden leprosy cases present today in our communities, that are suffering with the lack of diagnosis either due to the low coverage by the health network, by the absence of contact examination or by the difficulties found by the health professionals to give the correct diagnosis of leprosy (19–21). The different entities believe that is imperative to have more robust data to support major decisions like this one, that would have a significant impact on the life of the leprosy community in the present and in the future.
Date of publishing Portuguese version: May 10th, 2018
Date of publishing English version: June 10th, 2018
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Claudio Guedes Salgado - President of the Brazilian Leprosy Society
Sérgio Cimerman - President of the Brazilian Society of Infectious Diseases
Paulo Velho - Representative of the Brazilian Association of Collective Health
Lincoln Lopes Ferreira - President of the Brazilian Medical Society
Marco Andrey Cipriani Frade – Coordinator of the leprosy National Reference Center at Ribeirão Preto, São Paulo
Isabela Goulart – Coordinator of the leprosy National Reference Center at Uberlândia, Minas Gerais
Nesio Fernandes – Representative of the National Counselor of Municipal Health Secretaries
Claudio Guedes Salgado
Presidente da Sociedade Brasileira de Hansenologia (SBH)
Secretaria e correspondências
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