Long-term risk for developing leprosy-related disability: a multi-centre longitudinal study from India

Background Leprosy is a chronic disease that can cause neurological manifestations long after the completion of multidrug therapy (MDT). Evidence is needed to inform the existing strategies for detection and management of disabilities post-MDT. The aim of the study is to assess the medium-to-long-term risk of developing disabilities among leprosy patients who completed their MDT treatment. Methods This is a longitudinal study of patients treated with MDT between April 2005 and March 2010 at their Primary Health Centre (PHC) and referred to LEPRA Society Referral Centres in Odisha and Telangana, India, for management of complications who were re-assessed in 2013 (follow up at > 5 years) and 2021 (follow up at >10 years) for their disability status and leprosy complications. Multivariable logistic regression was used to identify risk factors at diagnosis associated with worsening of disability grade from diagnosis to follow-up or having continued with the grade-2 disability, defined as the negative outcome. Results A total of 326 consenting patients participated in both 2013 and 2021. At the time of diagnosis, 7% had grade-1 disability (G1D) and 11% had grade-2 disability (G2D). The risk ratio of having G1D and G2D five years of post-MDT was 1.14 and 0.94, respectively whereas the risk ratio for G2D increased to 1.28 after 10 years from diagnosis. The factors associated with the negative outcome were having multibacillary type (MB) disease, having more than one nerve involvement, and the presence of leprosy reaction at the time of diagnosis. Conclusion MB patients with nerve thickening and reactions at the time of diagnosis need a follow-up plan before being released from MDT treatment and dedicated patient education for complication recognition, timely health seeking, and facilitated access to care where needed.