Evaluation of clinical and demographic profile of leprosy with special reference to WHO-fixed duration multidrug therapy non-responders: a cross-sectional analysis at a tertiary care centre in Maharashtra


  • Monali Sahu Department of Dermatology, BJ Govt. Medical College, Pune, Maharashtra, India
  • Vasudha Belgaumkar Department of Dermatology, BJ Govt. Medical College, Pune, Maharashtra, India
  • Ravindranath B. Chavan Department of Dermatology, BJ Govt. Medical College, Pune, Maharashtra, India




Leprosy, Non-responders, MDT, Fixed duration, Relapse, NLEP


Background: India remains one of the highest contributors to the global burden of leprosy despite declaring elimination in 2005 under National Leprosy Elimination Program (NLEP). The objective of this study was to document the clinical and socio-demographic profile of leprosy patients, determine the proportion suspected with inadequate/non-response to standard World Health Organisation (WHO)-Fixed duration multi drug therapy (FD-MDT) and identify contributory factors.

Methods: A cross-sectional study was conducted on 123 leprosy patients over 2 months. Screened patients were categorised into suspected MDT non-responders (Group A, 21) and those not satisfying criteria (Group B, 102) for non-responders. Medical records were abstracted and patients subjected to detailed history and clinical examination.

Results: Burden of WHO-MDT non-responders was 17 % (mean age 37.64 years).Majority were male in both groups. Borderline lepromatous (33%) and borderline tuberculoid (58%) were the predominant types in group A and B respectively. Among non-responders, male gender and grade 1disabilitywere significant associations, 17 were on extended-MDT;1 patient was prescribed second-line drugs,3 received both MDT and second-line drugs. More-than-half had relapsed within 5 years.

Conclusions: This study highlights the need for customised-treatment in selective situations to minimise relapses. Determinants in WHO-FD-MDT non- responders/relapse cases were male gender, young adults, lower socioeconomic status, lepromatous form, disability, high initial bacteriological index, non-compliance and early relapses. Leprosy eradication can be facilitated by individually focused management strategies including judicious use of bacteriological index, counseling and long- term follow-up depending on the patient profile. Active surveillance and early detection of relapse may prevent further complications and decrease drug resistance.  

Author Biographies

Monali Sahu, Department of Dermatology, BJ Govt. Medical College, Pune, Maharashtra, India

Intern Doctor, BJ Govt. Medical college Sassoon General Hospital, Pune, Maharashtra, India-411001.

Vasudha Belgaumkar, Department of Dermatology, BJ Govt. Medical College, Pune, Maharashtra, India

Associate Professor, Department of Dermatology, BJ Govt. Medical College, Pune-411001

Ravindranath B. Chavan, Department of Dermatology, BJ Govt. Medical College, Pune, Maharashtra, India

Professor and Head, Department of Dermatology,BJ Govt. Medical, Pune-411001.


WHO: Leprosy: the disease. Available at: https://www.who.int/lep/leprosy/en/. Accessed on 24th Jan.2019.

Smith DS, Bronze MS. What is the Ridley-Jopling classification of leprosy? 2018. Available at: https://www.medscape.com/answers/220455-91301/what-is-the-ridley-jopling-classification-of-leprosy. Accessed on 24th Jan2019.

Rao PN, Suneetha S. Current Situation of Leprosy in India and its Future Implications. Indian Dermatology Online J. 2018;9(2):83-9.

Status of Leprosy in the country. Available at: http://nlep.nic.in/pdf/Status%20of%20Leprosy%20in%20the%20country%20(March%202018).pdf. Accessed on 24th Jan2019.

Kaimal S, Thappa DM. Relapse in leprosy. IJDVL year. 2009;75(2):126-35.

Kumar A1, Girdhar A, Girdhar BK. Six months fixed duration multidrug therapy in paucibacillary leprosy: risk of relapse and disability in Agra PB cohort study.

Norman G, Joseph G, Richard J. Relapses in multibacillary patients treated with multi-drug therapy until smear negativity: findings after twenty years. Available at: https://pubmed.ncbi.nlm.nih. gov/15217321/. Accessed on 20th august 2021.

Chen XS, Li WZ, Jiang C, Ye GY. Studies on risk of leprosy relapses in China: relapses after treatment with multidrug therapy. 1999. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10700911. Accessed on 30th August 2019.

Cellona RV, Balagon MF, dela Cruz EC, Burgos JA, Abalos RM, Walsh GP et al. Long-term efficacy of 2 year WHO multiple drug therapy (MDT) in multibacillary (MB) leprosy patients. 2003. Available at: https://europepmc.org/article/med/ 14763888. Accessed on 21st august 2021.

Uikey D, Joshi R, Shah BJ, Verma N. Leprosy Scenario in Ahmedabad District (Gujarat). Indian journal of dermatology. 2019;64:5.

Girdhar BK, Girdhar A, Kumar A. Relapses in multibacillary leprosy patients: effect of length of therapy. 2000. Avaialble at: https://pubmed.ncbi. nlm.nih.gov/10920610/. Accessed on 21st august 2021.

WHO: leprosy elimination. Available at:https://www.who.int/lep/microbiology/en/. Accessed on 30th September, 2019.

Report of the Workshop on sentinel surveillance for drug resistance in leprosy. 2008. Available at: earo.who.int/entity/global_leprosy_programme/topics/sentinel_surv_meeting_2008.pdf?ua=1. Accessed on 30th September, 2019.






Original Research Articles