Multidrug therapy against leprosy : development and implementation over the past 25 years

Overview

For centuries, the care of leprosy patients was mired in ignorance, prejudice, and denial. Universal fear led to “lepers” being isolated, couples separated, and children removed from their parents. While isolation may not have been entirely ineffective in reducing the transmission of the disease, it was often a tragedy for the patients, leaving them with no hope of cure or redemption, for no treatment existed at the time.

The only drug available was chaulmoogra oil, ex tracted from the nut of a tree native to India, where it had been used for centuries. Ad ministered as an oint ment, by injection or by mouth, chaulmoogra oil was, in the words of one leprologist, given “externally, internally and eternally” – but to no great avail, since it was largely ineffective.

For the majority of leprosy patients, isolation was shown to be pointless. There are now known to be two main clinical types of leprosy. In 1936, in Cebu, Philippines, Doull et al. demonstrated that patients affected with one of these types – corresponding roughly to what would today be called paucibacillary leprosy – had a very low potential for transmitting the disease. Segregation of those patients was thus irrelevant.

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As early as 1965, following a suggestion by Cochrane in 1959 that drug resistance would explain the unchanged status of leprosy in some patients, Spickett argued for the concurrent use of two or more drugs, even though the immediate clinical improvement might be no greater than that produced by any one of the drugs used alone. While many clinicians considered that combined use of drugs should enhance their therapeutic activity (a synergistic effect) or accelerate cure, this was in no way the purpose: as stressed by Rees, the paramount objective of combined therapy was to reduce the incidence of drug resistance resulting from monotherapy to insignificant proportions.