Fixed duration MDT in paucibacillary leprosy (classical and modified).
We analyzed the records of 1022 patients of paucibacillary leprosy who had received either 6 doses of WHO-MDT alone (" classical" MDT, 668 patients) or had post-MDT dapsone for at least 6 months ("modified" MDT, 354 patients). The duration of posttherapy surveillance ranged from 6 months to 7 years (mean 20.4 months). We found that the incidence of unfavorable events was significantly higher with the classical regimen when patients were graded as active at the end of the fixed duration regimen, especially when patients with > 2 lesions were considered. In the patients who were graded as inactive at the end of 6 doses, there was a slight excess of unfavorable events in the modified regimen, although not statistically significant. No correlation was found between unfavorable events and the regularity of treatment or the lepromin status. Overall, the incidence of adverse events was higher in patients with multiple lesions, and more than 90% of the adverse events occurred during the first 2 years of follow up. It is felt that 6 doses of MDT is adequate in the majority of patients who have few lesions or who have become inactive at the end of the treatment period. However, caution should be exercised in those with multiple lesions or in those considered active at the end of 6 doses.