Drug trial raises hopes over leprosy

06 May 2016

AP

Managing: an Indian resident of a leper colony in New Delhi writes notes, in February, 2014. Fifty-eight per cent of leprosy patients are to be found in India

Managing: an Indian resident of a leper colony in New Delhi writes notes, in February, 2014. Fifty-eight per cent of leprosy patients are to be found ...

THERE could be new hope for people affected by leprosy if the trial of a new drug continues to give positive results, the Leprosy Mission (England and Wales) has announced.

The drug — Rifampicin — is currently being used by Novartis Foundation, the charitable arm of the pharmaceutical giant Novartis, in order to prevent the spread of the disease from those infected to those at risk of infection.

Leprosy is a bacterial disease that causes discolouration and lumps on the skin, and can lead to irreversible disabilities, including blindness, if treated too late. It occurs where dirty water, poor nutrition, and poor standards of living are the norm, and where immune systems become too weak to fight infection.

The new initiative is known as the leprosy post-exposure prophylaxis (LPEP), and is being piloted in Asia, Africa, and Latin America. It is funded by the Novartis Foundation, which is working with the International Federation of Anti-Leprosy Associations, and the governments of each country.

In the first trial, about 20,000 people who were in contact with those diagnosed with leprosy were given a single dose of either rifampicin or a placebo, the Leprosy Mission stated in a release last week. After two years, there were 60 per cent fewer new cases among contacts who had had the rifampicin than among those who had had the placebo.

A volunteer medical adviser for the Leprosy Mission, Dr Ruth Butlin, said: “We thought that if people have ‘sub-clinical infection’ — i.e. they are not ill with leprosy, but might progress to having the disease — they could be prevented from getting the disease with a single dose of the drug.”

Rifampicin is already used in the UK to prevent the spread of meningitis, and is an important component in the treatment of tuberculosis. It is also one of three anti-bacterial drugs used to cure leprosy.

Novartis has been distributing this treatment — a combination of three antibiotics: rifampicin, clofazimine, and dapsone — to governments since 2000, through the World Health Organization (WHO).

The multi-drug therapy was first introduced in 1982, after which new cases of diagnosed leprosy declined from 5.3 million in 1985 to 300,000 in 2005. The WHO later announced that the disease had been “eliminated as a public-health problem”, as less than one person in 10,000 was registered as having an active case of the disease.

The Global Program Head of Health Impact at Novartis Foundation, Dr Bart Vander Plaetse, said that the expectation was for the therapy to cause a drop in the transmission of the disease, leading to its eventual elimination.

“But that has not been the case,” he said. “To the contrary, the approach of declaring leprosy eliminated as a public-health problem led to some countries’ losing interest.”

He went on: “We knew we can treat leprosy, but asked ourselves: was there something we could do to prevent it? So we started looking at different ways of stopping the transmission of the disease.”

A dozen health volunteers for LPEP in Nepal have been travelling to the Kapilvastu, Rupandehi, and Parsa districts in search of those who have been recently diagnosed. When a case is confirmed, they refer the patient to a specialist team for treatment, and screen those who have been in close contact, such as friends and family, to check for symptoms.

If those contacts are healthy, and they have no underlying illnesses, those over five years old are given a single dose of Rifampicin.

Dr Vander Plaetse said: “[In the first two years] we expect to see a spike in the number of new diagnoses, because our partners will be actively searching for new cases; but after two or three years we hope to see a reduction.”

Preliminary findings of the LPEP trials will be presented at the 19th International Leprosy Congress in Beijing in September. The results are expected to contribute to WHO recommendations in the future.

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