Study shows bedaquiline monotherapy may improve skin lesions in patients with multibacillary leprosy

In recent years, the treatment of leprosy has attracted widespread attention from the medical community, especially effective treatment options for patients with multibacillary leprosy. Against this backdrop, a new study suggests that bedaquiline, as monotherapy, may significantly improve skin lesions in patients with multibacillary leprosy and help eliminate Mycobacterium leprae from the body. This research provides new ideas and hope for the treatment of leprosy.

Leprosy is a chronic bacterial infection caused by Mycobacterium leprae (Mycobacterium leprae), which usually manifests as damage to the skin, peripheral nerves, upper respiratory tract and eyes. Also known as Hansen's disease, the disease is known for its severe physical and psychological effects on sufferers. Leprae is a Gram-positive, obligate intracellular bacterium belonging to the order Actinomycetes and the family Mycobacteriaceae. It is acid-resistant and mainly infects Schwann cells in peripheral nerves and phagocytes in the skin. This unique characteristic of the infection makes the treatment of leprosy complex and challenging.

Over the past year, multidrug therapy has been the standard treatment for multibacillary leprosy. However, the emergence of drug resistance and side effects brings significant challenges to treatment, and patients often face the dual problems of poor treatment effects and physical discomfort. The World Health Organization (WHO) emphasizes the need to develop shorter, more effective treatment regimens to improve patient compliance and quality of life. Bedaquiline, a diarylquinoline drug, has demonstrated its potential in the treatment of various leprosy infections by inhibiting mycobacterial ATP synthase.

A prospective study was conducted to evaluate the efficacy of bedaquiline in untreated patients with multibacillary leprosy. The study was conducted in Brazil, and patients were randomly assigned to bedaquiline monotherapy for 8 weeks. After these 8 weeks, the patient began receiving standard multidrug therapy recommended by WHO and was followed up for 112 weeks. The primary outcome measure of the study was to assess change from baseline in the probability of M. leprae growth in the mouse footpads, with exploratory final objectives including changes in clinical signs and symptoms and testing of the viability of M. leprae molecules by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR).

Based on a modified intention-to-treat analysis, a total of 9 patients were included in the study. After 4 weeks of bedaquiline monotherapy, the probability of leprae-positive growth in all patients decreased from 100% at baseline to 0%. This is an encouraging result and shows the significant effectiveness of bedaquiline in eliminating M. leprae. In addition, after 7 weeks of treatment, the patient's skin lesions improved significantly and the appearance of the skin lesions was better than at the beginning of treatment, which provides additional confidence to doctors and patients.

A total of7 patients experienced at least one adverse event during the study, but all were grade 1 or 2, indicating a relatively high safety profile of the treatment. This means that bedaquiline can not only effectively eliminate Mycobacterium leprae, but is also well tolerated by patients, providing an important basis for its application as a new treatment option for leprosy.

Reference: https://medicaldialogues.in/dermatology/news/bedaquiline-monotherapy-may-improve-skin-lesions-in-multibacillary-leprosy-patients-suggests-study-144776