Acceptability of any regimen is important. This has been very good with the current regimens except occasionally perhaps for the clofazimine component but because clofazimine may be important in the prevention of reactions and neuritis it would generally be inadvisable to recommend dropping it from the regimen and replacing it with something else.
Simplicity of regimens is useful to encourage patient compliance and at the same time could make it easier for those treating the disease by, for example, having a single regimen for all cases of leprosy, both multibacillary and paucibacillary. On the other hand, one has to ask whether this would be cost effective given the fact that multibacillary disease generally will require more therapy than paucibacillary disease. In any event, the current regimens using blister packs are relatively simple and perhaps as simple as we can make therapy, at least in terms of delivery.
There are a number of ongoing trials which do offer the prospect of perhaps simplifying therapy and improving efficacy. One such trial involves the use of a single dose of ROM for all paucibacillary cases. A second involves the use of a single dose of ROM monthly for 3 or 6 months for paucibacillary cases and 12 or 24 months for multibacillary cases. Finally, there is a trial involving the use of 600 mg of rifampicin + 400 mg of ofloxacin daily for I month for all types of leprosy. The results of all of these should be available within the next few years. Finally, there are vaccine trials underway which could possibly decrease the incidence of the disease at least in areas with a very high incidence.
Conclusions：
It is clear that significant problems remain in defining disease and the best possible antibacterial regimens. I am hopeful, however, that in the open discussions later this morning and the deliberations of the workshop group this afternoon we can develop a consensus on the various issues for presentation to the Congress later this week.
R. Jacobson, GW Long Hansen's Disease Center, LA, U.S.A
