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

• Main Authors: Selma Regina Penha Silva Cerqueira, Lais Sevilha dos Santos, Elaine Faria Morelo, Agenor de Castro Moreira dos Santos Júnior, Carlos Augusto Felipe de Sousa, Renata Trindade Gonçalves, Gunter Hans Neto, Daniel da Silva Marques, Raimunda Nonata Ribeiro Sampaio, Patrícia Shu Kurizky, Ciro Martins Gomes
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT)
• Series: Revista da Sociedade Brasileira de Medicina Tropical
• Subjects: leprosy; polypharmacy; therapeutics; treatment failure
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822020000100326&lng=en&tlng=en

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.