利莫霉素:基于有效敏感性恢复治疗汉森氏病的新治疗方案

IF 3 4区 医学 Q2 INFECTIOUS DISEASES
Marco Andrey Cipriani Frade , Gustavo Sartori Albertino , Filipe Rocha Lima , Natália Aparecida de Paula , Fabiana Aparecida Correa Cinto , Fernanda Cruz Perecin , Andrezza Westin , Wilson Marques Junior , Helena Barbosa Lugão
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引用次数: 0

摘要

自1982年以来,世界卫生组织(WHO)推荐多药治疗(MDT/WHO)治疗汉森病(HD);然而,复发、抗菌素耐药性和不良反应表明需要新的治疗方案。我们评估了新的抗hd方案RIMOXCLAMIN(利福平、莫西沙星、克拉霉素和米诺环素)与世界卫生组织提供的标准多药治疗(MDT/WHO)的疗效和安全性。方法/主要发现对2015年至2023年间66例多菌性HD新病例(46例:RIMOXCLAMIN / 20例:MDT/WHO)进行了评估。患者至少每两个月由神经科医生随访一次,以了解神经和皮肤的发现以及治疗的副作用。在诊断、第3、6、12个月进行Semmes Weinstein单丝(SWM)手/脚触觉灵敏度测试和肢体残疾分级(PDG)。RIMOXCLAMIN组和MDT/WHO组分别有84.8%和80%的患者被划分为边缘性-边缘性(BB),两组间差异无统计学意义(p = 0.12)。两组患者触诊后神经增厚均有所减轻:利莫昔霉素组患者的神经增厚较早出现(6个月时65% ~ 28%,p = 0.03;12个月时为9%,p = 0.03),而在MDT/WHO中较晚(12个月时为95%至40%,p = 0.002)。6个月时差异最大(p <;0.0001)。仅用利莫昔霉素治疗第3个月,疼痛量表明显减轻;最后,两组疼痛程度均有明显减轻,利莫霉素组疼痛程度更大。与基线相比,手上的异常SWM点数减少0.5%,而在MDT/WHO组中,异常点数增加了5.4%。在脚上,RIMOXCLAMIN显示减少17.9%,而在MDT/WHO中,这是10.3%。在随访期间,与MDT/WHO相比,RIMOXCLAMIN显示SWM改变点的总和显著减少(p <;0.05)。只有利莫霉素改善了PDG监测。两组都报告了轻微的不良反应。结论/意义:结果表明,RIMOXCLAMIN在神经损伤的快速恢复方面优于MDT/WHO,早在第3个月就能改善手足症状和敏感性,并在治疗结束后持续改善,包括PDG患者的减少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
RIMOXCLAMIN: New therapeutic regimen for Hansen’s Disease cure based on effective sensitivity recovery

Background

World Health Organization (WHO) has recommended Multidrug Therapy (MDT/WHO) for Hansen’s Disease (HD) since 1982; nevertheless, relapse, antimicrobial resistance, and adverse reactions indicate the need for new therapeutic regimens. We evaluated the efficacy and safety of the new anti-HD regimen RIMOXCLAMIN (Rifampicin, Moxifloxacin, Clarithromycin, and Minocycline) compared with standard Multidrug Therapy provided by WHO (MDT/WHO).

Methodology/principal findings

66 multibacillary HD new cases (46: RIMOXCLAMIN / 20: MDT/WHO) were evaluated between 2015 and 2023. Patients were followed up at least bimonthly by hansenologists for neurological and cutaneous findings and side effects of treatments. Hands/feet tactile sensitivity tests by Semmes Weinstein Monofilaments (SWM) and Physical Disability Grade (PDG) were carried out on the diagnosis, 3rd, 6th, and 12th months. 84.8 % and 80 % of the patients were classified as Borderline-Borderline (BB) in RIMOXCLAMIN and MDT/WHO groups, respectively, with no significant difference between them (p = 0.12). Nerve thickening was reduced by palpation in both groups: in RIMOXCLAMIN, reduction occurred early (65 % to 28 % at 6-months, p = 0.03; 9 % at 12-months, p = 0.03), while in MDT/WHO, it was later (95 % to 40 % at 12-months, p = 0.002). The greatest difference was at 6 months (p < 0.0001). A significant reduction was observed in pain scales on the 3rd month of treatment only with RIMOXCLAMIN; in the end, both groups showed significant reductions in pain scales, being greater in RIMOXCLAMIN group. 0.5 % reduction in the number of abnormal SWM points on the hands compared to baseline, while in the MDT/WHO group, there was an increase of abnormal points of 5.4 %. On the feet, RIMOXCLAMIN showed a reduction of 17.9 %, while in the MDT/WHO, it was 10.3 %. During follow-up, the RIMOXCLAMIN showed a significant decrease in the sum of altered SWM points compared to MDT/WHO (p < 0.05). Only RIMOXCLAMIN improved PDG monitoring. Both groups reported mild adverse effects.

Conclusions/significance

The results indicate that RIMOXCLAMIN was superior to MDT/WHO in terms of quick recovery of neurological damage, evidenced by the improvement of symptoms and sensitivity in hands and feet as early as the third month, with a progressive improvement, maintained after the end of treatment, including a reduce of patients with PDG.
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
925
审稿时长
41 days
期刊介绍: The Brazilian Journal of Infectious Diseases is the official publication of the Brazilian Society of Infectious Diseases (SBI). It aims to publish relevant articles in the broadest sense on all aspects of microbiology, infectious diseases and immune response to infectious agents. The BJID is a bimonthly publication and one of the most influential journals in its field in Brazil and Latin America with a high impact factor, since its inception it has garnered a growing share of the publishing market.
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