TY - JOUR KW - Adolescent KW - Adult KW - Aged KW - Ambulatory Care Facilities KW - Brazil KW - Child KW - Child, Preschool KW - Cohort Studies KW - Disability Evaluation KW - Disabled Persons KW - Disease Progression KW - Drug Therapy, Combination KW - Female KW - Humans KW - Leprostatic Agents KW - Leprosy, Multibacillary KW - Male KW - Middle Aged KW - Nervous System Diseases KW - Patient Discharge KW - Proportional Hazards Models KW - Risk Factors KW - Young Adult AU - Sales A AU - Campos DP AU - Hacker MA AU - Costa Nery JA AU - Duppre NC AU - Rangel E AU - Sarno E AU - Penna MLF AB -

OBJECTIVE: To evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO).

METHODS: Cohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics.

RESULTS: The total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02-2.56), when disability was 2, the risk was 2.37 (95% CI 1.35-4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07-3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08-2.52]).

CONCLUSION: Impairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.

BT - Tropical medicine & international health : TM & IH C1 - http://www.ncbi.nlm.nih.gov/pubmed/23937704?dopt=Abstract CN - SALES 2013 DA - 2013 Sep DO - 10.1111/tmi.12156 IS - 9 J2 - Trop. Med. Int. Health LA - eng N2 -

OBJECTIVE: To evaluate the risk factors related to worsening of physical disabilities after treatment discharge among patients with leprosy administered 12 consecutive monthly doses of multidrug therapy (MDT/WHO).

METHODS: Cohort study was carried out at the Leprosy Laboratory in Rio de Janeiro, Brazil. We evaluated patients with multibacillary leprosy treated (MDT/WHO) between 1997 and 2007. The Cox proportional hazards model was used to estimate the relationship between the onset of physical disabilities after release from treatment and epidemiological and clinical characteristics.

RESULTS: The total observation time period for the 368 patients was 1 570 person-years (PY), averaging 4.3 years per patient. The overall incidence rate of worsening of disability was 6.5/100 PY. Among those who began treatment with no disability, the incidence rate of physical disability was 4.5/100 PY. Among those who started treatment with Grade 1 or 2 disabilities, the incidence rate of deterioration was 10.5/100 PY. The survival analysis evidenced that when disability grade was 1, the risk was 1.61 (95% CI: 1.02-2.56), when disability was 2, the risk was 2.37 (95% CI 1.35-4.16), and when the number of skin lesions was 15 or more, an HR = 1.97 (95% CI: 1.07-3.63). Patients with neuritis showed a 65% increased risk of worsening of disability (HR = 1.65 [95% CI: 1.08-2.52]).

CONCLUSION: Impairment at diagnosis was the main risk factor for neurological worsening after treatment/MDT. Early diagnosis and prompt treatment of reactional episodes remain the main means of preventing physical disabilities.

PY - 2013 SP - 1145 EP - 1153 T2 - Tropical medicine & international health : TM & IH TI - Progression of leprosy disability after discharge: is multidrug therapy enough? UR - http://onlinelibrary.wiley.com/doi/10.1111/tmi.12156/pdf VL - 18 SN - 1365-3156 ER -