Avaliação dos efeitos adversos e comorbidades dos pacientes tratados com poliquimioterapia para Hanseníase em 13 anos no Hospital Universitário Pedro Ernesto

Abstract

Leprosy is still a public health problem in Brazil, it is a neglected disease and can lead to physical disabilities in patients in productive age. Since 1994, the Ministry of Health and the World Health Organization have advocated the Multidrug therapy (MDT) for the treatment of leprosy, aiming to reduce the prevalence of the disease, as well as drug resistance. The polychemotherapeutic scheme used is based on the patient's classification in Paucibacillary or Multibacillary. The paucibacillary form comprises indeterminate leprosy, tuberculoid and most of the borderline-tuberculoid, and the multibacillary form includes the borderlines and Virchowians. Patients classified clinically and laboratorially as Paucibacillary are treated with two drugs: rifampicin and dapsone. Multibacillary patients are treated with the same regimen plus clofazimine and the treatment time is prolonged for at least six months, to 12 or 24 months. The main causes of maintenance of leprosy transmission are the late diagnosis and the abandonment of treatment. An observational, analytical, retrospective cohort study was carried out based on the analysis of medical records of 371 patients diagnosed with leprosy at the Pedro Ernesto University Hospital (HUPE) from January 2002 to December 2014. We assessed epidemiological and demographic data from the total and from the 196 followed-up in our service. Most of the patients were between 15 and 45 years old (43.88%), men and women are affected by the disease in similar proportions, but women have milder forms of the disease while menhave more severe presentation. The lowest level of education was related to the most severe forms and the highest degrees of disability of the disease. The most common comorbidities were systemic arterial hypertension and diabetes mellitus with prevalences similar to those of the general population, 31 other comorbidities were reported. Regarding the adverse effects (AE) with MDT, 30.27%(56) of the patients follow-up showed some alteration, and in 16.21%(30) of the cases, the implied drug was replaced. Older age is a risk factor for AE, each year of age increases risk by 2%. The most frequent AEs were acute and chronic hemolytic anemia (30.35% and 42.85%), followed by gastrointestinal alterations (19.64%). The sulphonic syndrome was described in three medical records. Of the AE, dapsone was the main drug involved. With regard to hematological AEs, it was observed that women were twice as affected. There was no lethal case. Based on this findings, in order to contribute to the strategy of decentralization of leprosy treatment, algorithms were also developed to enhance identification and therapeutic management of the most likely or severe AE, so that experience of a quaternary hospital could help primary care to manage patients undergoing leprosy treatment.