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Case Reports
. 2022 Nov 8:9:20499361221135885.
doi: 10.1177/20499361221135885. eCollection 2022 Jan-Dec.

Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States

Carlos Franco-Paredes  1   2 , Elizabeth Garcia-Creighton  3 , Andrés Henao-Martínez  2 , Diane L Kallgren  4 , Rashmi Banjade  5 , Jon A Dyer  6 , Taylor Nelson  6 , Araya Zaesim  6 , Michael J Peluso  7 , Vivek Jain  7 , Dong Heun Lee  8 , Lucio R Minces  9 , Mary Wirshup  10 , Miguel Sierra Hoffman  11   12 , Jenn Katsolis  13 , Karen Brust  14 , Jose Giron  15 , Lauren Smiarowski  15 , Pauline A Hoosepian-Mer  16 , Barbara Stryjewska  17
Affiliations
Case Reports

Novel approaches in the treatment of Hansen's disease (Leprosy): a case series of multidrug therapy of monthly rifampin, moxifloxacin, and minocycline (RMM) in the United States

Carlos Franco-Paredes et al. Ther Adv Infect Dis. .

Abstract

The World Health Organization (WHO) recommends multidrug therapy (MDT) for the treatment of paucibacillary and multibacillary forms of leprosy, also known as Hansen's disease (HD). MDT combinations of dapsone, rifampin, and clofazimine have reduced the prevalence of the disease but are not without adverse effects impacting regimen adherence. Hence, an urgent need exists to consider alternative MDT regimens with an improved safety profile that promotes treatment adherence. Herein, we described a case series of 10 patients with HD (nine patients with multibacillary leprosy and one with pure neural leprosy) treated with monthly rifampin, moxifloxacin, and minocycline (RMM). The United States National Hansen's Disease Program (NHDP) diagnosed and treated patients across US institutions. All patients received a regimen of 12-24 months of RMM. We reviewed the clinical outcomes, adherence, rate of completion, and adverse events of patients treated with monthly RMM from January 2019 to August 2022. Nine patients had multibacillary leprosy, with some having type-2 reactions. One patient had pure neural leprosy with a reversal reaction. In this case series, we identified that all patients completed the RMM regimen without treatment interruptions. None of the patients experienced any skin hyperpigmentation or any significant side effects. All patients tolerated the monthly RMM regimen with rapid improvement of skin lesions and without logistic hurdles. Based on previous clinical evidence and the results of this case series, the NHDP and other programs should consider the RMM regimen as first-line therapy.

Keywords: Hansen’s disease; clofazimine; leprosy; methotrexate; moxifloxacin; multidrug therapy; prednisone; rifampin.

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Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Henao-Martínez reported receiving a K12-clinical trial award as a co-principal investigator for the Expanded Access IND Program (EAP) to provide the Yellow Fever vaccine (Stamaril) to persons in the United States outside the submitted work. The Editor-in-Chief of Therapeutic Advances in Infectious Disease is an author of this paper, therefore, the peer review process was managed by alternative members of the Board and the submitting Editor had no involvement in the decision-making process. No other disclosures were reported.

Figures

Figure 1.
Figure 1.
Clinical images of three patients with Hansen’s disease who completed a WHO-recommended MDT who developed clofazimine-induced pigmentation. (Arrow) clofazimine placed in a spoon demonstrating its pigment and consistency.
Figure 2.
Figure 2.
A 20-year-old male with multibacillary Hansen’s disease (nodular lepromatous) treated with monthly rifampin, minocycline, and moxifloxacin and demonstrated rapid clinical improvement of skin nodules and plaques. This patient completed a 24-month course of monthly ROM with adequate adherence to the regimen and no adverse events without evidence of skin lesions or hyperpigmentation.
Figure 3.
Figure 3.
A 72-year-old female with multibacillary Hansen’s disease (nodular lepromatous) treated with monthly rifampin, minocycline, and moxifloxacin, and demonstrated clinical improvement in the size and appearance of the plaques. This patient completed a 12-month ROM with adequate adherence to the regimen and no adverse events without evidence of skin lesions or hyperpigmentation.
Figure 4.
Figure 4.
A 70-year-old male with multibacillary Hansen’s disease (borderline lepromatous leprosy) treated with rifampin, minocycline, and moxifloxacin demonstrating substantial improvement after 24 months of therapy.
See this image and copyright information in PMC

References

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