The interference of polypharmacy and the importance of clinical pharmacy advice in the treatment of leprosy: a case-control study.

Selma Regina Penha Silva Cerqueira,Patrícia Shu Kurizky,Renata Trindade Gonçalves,Carlos Augusto Felipe De Sousa,Agenor De Castro Moreira Dos Santos Júnior,Raimunda Nonata Ribeiro Sampaio,Gunter Hans Neto,Lais Sevilha Dos Santos,Daniel Da Silva Marques,Ciro Martins Gomes,Elaine Faria Morelo

doi:10.1590/0037-8682-0114-2020

Abstract

INTRODUCTION: Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. METHODS We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR). RESULTS: This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p < 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p < 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations. CONCLUSIONS: Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy.

Highlights

Supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed
We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy
Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79–9.12; p < 0.001)

Summary

Introduction

Supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. Methods: We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multidrug therapy (MDT), standardized by the World Health Organization (WHO), comprises a combination of drugs against M. leprae and patients are cured after 6 and 12 months of treatment, respectively, for paucibacillary and multibacillary leprosy[4]. There is a consensus that supervised doses are essential for reducing the risk of treatment failure, more complex approaches such as polypharmacy are not commonly performed, and the impact of these approaches has rarely been studied[3]. Analgesics, anti-inflammatories, antibiotics, and proton-pump inhibitors are often used in the course of leprosy treatment, introducing an important challenge, especially in primary health care facilities[8]

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