Leprosy Relapse After Polychemotherapy: A Systematic Review And Meta-Analysis

Objective: To synthesize the best scientific evidence related to estimating the prevalence of leprosy relapse cases after polychemotherapy treatment. Method: A systematic review was conducted following the JBI methodology for systematic reviews of prevalence studies, and the reporting stage adhered to PRISMA-P, with registration No.: CRD42020177141. The inclusion criteria were adopted following the PopCoCo mnemonic (Population, Condition, Context). Population: people of both genders and any age, diagnosed with leprosy relapse, and treated with paucibacillary or multibacillary therapeutic regimes. Condition: leprosy relapse after Polychemotherapy (PCT) estimated as a proportion of cases. Context: studies conducted within the scope of health services. Databases used: Medline, LILACS, Embase, CINAHL, Scopus, WoS, CARPHA; Mendeley reference manager. A random-effects meta-analysis model was applied, and heterogeneity was assessed using the Higgins test. Results: Out of 41 studies included in the review, involving a total of 93,461 patients with leprosy, 4.09% (n=3,830) were eligible for relapse after polychemotherapy. Of them, 69.71% (n=2,670) were treated both with multibacillary and with paucibacillary regimes (72.36%, n=1,932; and 27.64%, n=738, respectively), and with a bacilloscopy index [≥]4. Relapse prevalence was observed in males and in people aged over 30 years old. The meta-analysis estimated the global prevalence of leprosy relapse at 11% (95%CI: 0.09-0.12), with higher prevalence rates in Brazil (31%) and India (13%). Conclusion: There is evidence of high global prevalence of leprosy relapse after PCT, with higher estimates in India and Brazil, countries burdened with higher prevalence of the disease. SYNTHESISAlthough leprosy us an ancient disease with a scientifically proven effective treatment, it remains a Public Health problem. This is not only due to the disease high prevalence but also to its potential to cause physical disabilities, leading to emotional and social impacts and, consequently, compromising quality of life. In addition to the new cases of the disease, another concern commonly reported in the literature is leprosy relapse after polychemotherapy, as it has repercussions on therapeutic effectiveness. The relapse causes are usually associated with therapeutic failure due to incomplete treatment, misclassification in the initial treatment, and multidrug resistance. This study provides insights to verify the disease current prevalence based on scientific evidence, which can contribute to expanding the prevention strategies.