Avaliação dos efeitos adversos às drogas (minocilina, ofloxacina e clofazimina) do esquema alternativo para tratamento da hanseníase multibacilar

Abstract

After introduction of multi-drug therapy (MDT/OMS) there were decline in prevalence coefficients and new cases detections, however, the records of drug resistance and relapse cases are threatening factors against lepra control, therefore, the importance of new alternative schemes and monitoring adverse effects, avoiding abandonment or irregularity to treatment. Objectives: Describe side-effects of multi-drug regimen containing minocycline, ofloxacin and clofazimine in multibacillary (MB) leprosy patients and analyse the clinicalbacteriologic indices. Materials and Methods: A prospective, descriptive and observational study, in multibacillary patients, including intolerance cases of standard MDT and relapse cases, carried out in Alfredo da Matta Foundation, Manaus, Amazonas, Brazil, during april 2010 and january 2012. The side-effects were recorded of every individual patient, filled during the course of alternative treatment. The patients received alternative therapy with daily self-administered doses of 100mg of minocycline, 400 mg of ofloxacin and 50mg of clofazimine and a month supervised dose of 300mg of clofazimine for 06 months, thereafter 18 months of daily self-administered doses of ofloxacin 400mg, clofazimine 50mg and month supervised dose of clofazimine 300mg. Results and Discussions: During research 26 patients were treated, however, of these, only 21 cases were included in this study. The mild and not persistent side-effects occurred in 33,3% of patients. From the 37 side-effects, 45,9% episodes was attributed to ofloxacin, such as abdominal pain, nausea, vomiting, headache and insomnia; 21,6% due to clofazimine, 100% of patients with skin pigmentation; however, no side-effets due to minocycline. Mean duration for the development of adverse effects from the start of therapy was 15,2 days. The media interval of follow-up was 13,7 months and 23,8% of patients completed the 24 months trerapy. All the patients tolerated the drugs well and the adhesion was satisfactory, among 15 patients that completed the first treatment year, 14 took 12 doses at 12 months from alternative regimen. Conclusion: The alternative therapy had a similar feasibility and operational mode from MB/MDT, with safe, well tolerated and good adhesion with no serious events. The side-effects attributed to alternative regimen were comparable to previous studies, however this new three drugs combination indicates the importance of these research results. No drug was stopped unlike others standard MDT studies which had treatment interruption by side-effects. There was significant correlation (p<0,001) between clinical classification and histopatologic diagnosis. At the end of first year, there was clinical improvement and bacteriologic index reduction. Nevertheless, it s necessary a follow-up and new inclusions to guarantee the efficacy and safe for the alternative regimen.