An evaluation of adverse drug reactions, adherence to treatment and quality of life in patients with leprosy receiving multidrug therapy in a tertiary care teaching hospital

Introduction: The introduction of multi drug therapy (MDT) by WHO has enabled effective cure of leprosy. However, MDT has always been associated with adverse drug reactions (ADRs). The success of leprosy treatment depends largely on adherence to the treatment regimen. Stigma associated with leprosy has a negative impact on quality of life (QoL). Therefore, it is important to assess the ADRs, and to analyze adherence and QoL in patients receiving MDT.

Materials and methods: A cross-sectional study was conducted over an 18-month period. In total, 180 patients were included. Causality assessment of ADR was done using the WHO-UMC & Naranjo scales, severity and preventability assessment were done using the Hartwig & Siegel and Schumock & Thornton scales, respectively. Evaluation of adherence was done by using the Morisky 8-item medication adherence scale (MMAS-8). Evaluation of QoL was done using WHO QoL-BREF.

Results: A total of 185 ADRs were found among 107 patients. Both transient mild ADRs like vomiting and hyperpigmentation of skin, and rare life threating ADRs like Dapsone Hypersensitivity Syndrome (DHS) and exfoliative dermatitis, were reported. According to the Naranjo scale, 124 ADRs were probable while according to UMC-WHO causality scale, 93 ADRs were possible. 99 ADRs were moderate followed by mild (82) and only four were severe. 121 ADRs were not preventable followed by probably preventable (64). 120 patients had medium adherence, 35 had low adherence and only six had high adherence. Our study showed that leprosy has great psychological and physical impact on the QoL of patients.

Conclusion: Systematic evaluation of ADRs, adherence and QoL is helpful to increase awareness and encourage the development of appropriate leprosy management interventions.