Leprosy is a chronic infectious-contagious disease with slow evolution, caused by Mycobacterium leprae , with important dermatoneurological manifestations. Despite the effectiveness of multidrug therapy (MDT) recommended by the Ministry of Health and WHO, adverse drug reactions may require substitution of the therapeutic regimen, which motivated this study. The objective was to clinically and epidemiologically characterize patients using substitute regimens treated at a leprosy reference center in Amazonas between January 2012 and December 2022. This is a retrospective, descriptive, cross-sectional study based on the analysis of medical records of leprosy patients using substitute regimens. Patients of both sexes and all age groups were included, and records with insufficient data were excluded. The analyzed variables included sex, age, clinical and operational form of the disease, degree of disability, bacilloscopy index, and reason for treatment substitution. During the analyzed period, 1,585 leprosy cases were diagnosed, of which 53 (3.34%) used substitute regimens. Most cases were male (54.7%), aged between 19 and 33 years (26.4%). The predominant clinical form was dimorphic (56.6%), and regarding operational classification, the multibacillary form predominated (77.4%). Regarding disability grade and bacilloscopy index, 47.2% had grade 0 and BI = 0, respectively. The main reason for substitution was anemia (39.6%), mainly in 2021 and 2022, reflecting the importance of laboratory surveillance. Although adverse effects were recorded as justification for changing the standard therapeutic regimen, in most cases it was not possible to confirm them laboratorially due to the absence of tests in digital medical records, highlighting an important limitation in clinical documentation and emphasizing the need for improvements in routine recording and standardization of adverse events. It is concluded that the use of substitute regimens, although infrequent, reflects a clinical challenge that indicates the need for laboratory monitoring strategies to ensure early and accurate detection of adverse effects, facilitating appropriate drug interventions and reducing unnecessary changes in therapeutic regimens.
Braga et al. (Sun,) studied this question.