Post-Multidrug Therapy Recovery in South Indian Leprosy Patients: A Prospective Study of Nerve Function, Reaction Incidence, and Psychosocial Adjustment

Background: Leprosy remains a major public health issue in endemic regions like South India, with nerve damage and psychosocial challenges persisting despite effective multidrug therapy (MDT). Early post-treatment monitoring is essential to detect nerve changes, reactions, and psychosocial adjustments impacting disability and quality of life. This study prospectively evaluated clinical progression, reaction incidence, psychosocial outcomes, self-care adherence, and preliminary oncological risks over six weeks post-MDT in 140 enrolled patients (112 completers). Methods: In a prospective cohort from January 2024 to June 2025, 140 adults with confirmed leprosy completing WHO MDT (6 months for paucibacillary [PB]; 12 months for multibacillary [MB]) were enrolled at a South Indian center. Assessments included nerve function (Semmes-Weinstein monofilaments, motor testing), disability (WHO grading), depression (PHQ-9), stigma (EMIC), quality of life (WHOQOL-BREF), and self-care adherence at baseline and 6 weeks. Oncological screening used symptom review and biomarkers. Analyses involved paired t-tests, chi-square, Pearson’s correlations, and Kaplan-Meier curves. Sample size was limited to 140 due to logistics, yielding >80% power based on pilot data. Results: Among 112 completers, PB patients showed significant improvements in Nerve Function Score (mean change −0.30, p=0.002) and WHO Disability Score (mean change −0.23, p=0.01). Reaction incidence was 18% (higher in MB [25%] vs. PB [13%]; p=0.04), mostly within 4 weeks. Psychosocial parameters (PHQ-9, EMIC, WHOQOL-BREF) improved significantly (p<0.01). Self-care adherence was ≥80% in 71%. No confirmed cancers; 3.6% had risk signs warranting referral. Conclusions: Early post-MDT care reveals neurological and psychosocial recovery with varying reactions, emphasizing multidisciplinary follow-up for optimal outcomes.