Coorte multicêntrica de pacientes com hanseníase tratada com terapiade dose única: resultados de três anos de seguimento e perspectiva emsáude pública no Brasil

Single skin lesion, paucibacillary (SSL-PB) leprosy is considered an early diseasemanifestation. This study evaluated the clinical outcome of a cohort of 259 newlydiagnosed SSL-PB treated with one dose of rifampicin, ofloxacin, minocycline (ROM)and followed-up for three-years. Patients were recruited from the North, Central Westand Southeast regions in Brazil (1997-2001). The result expected with ROM therapywas disappearance or the reduction of lesion size. Manifestations that required additional intervention were considered as poor clinical outcome: type-1 reaction (T1R) with orwithout neuritis, neuritis alone, increase in lesion size and shift from paucibacillary tomultibacillary. The incidence of poor clinical outcome was calculated by personmonthand with the Kaplan-Meier methods. 61.8% of the participants were females,mean age 32.2, and 67.2% had borderline tuberculoid (BT) or tuberculoid forms. T1Rwas the predominant event; shift from paucibacillary to multibacillary was rare. 92.0%of the volunteers shown no events during the first year, the same occurring to 80.6%of them after 3 years of clinical monitoring. The probability of remaining event-freewas highest among those 40 years old or younger. Poor outcome predominated amongBT patients. Extended monitoring of SSL-PB leprosy cases under minimal therapyprovided valuable case management information for reference centers. Lesao unica paucibacilar (SSL-PB) e considerada manifestacao clinica inicial dahanseniase. Este estudo avaliou resultado clinico de coorte de 259 pacientes SSL-PBrecem-diagnosticados, tratados com esquema de dose unica Rifampicina, Ofloxacina,Minociclina (ROM) e acompanhados por 3 anos (1997-2001) nas regioes Norte,Centro-Oeste e Sudeste. O resultado esperado do tratamento ROM compreendedesaparecimento ou diminuicao da lesao. O desfecho foi definido como qualquerevento clinico com indicacao de terapia adicional: reacao tipo 1 (T1R) com ou semneurite, neurite, aumento de tamanho de lesao e mudanca de paucibacilar paramultibacilar. Estas manifestacoes foram consideradas eventos clinicos desfavoraveis,calculados por densidade de incidencia (pessoa-tempo) e por Kaplan-Meier. 61,8%dos participantes eram mulheres (32,2 media idade), 67,2% borderline-tuberculoide(BT) e tuberculoide. T1R foi o desfecho predominante; mudanca de paucibacilar paramultibacilar foi rara. 92,0% nao apresentaram eventos desfavoraveis no primeiro anoe 80,6% ao final de tres anos de monitoramento clinico. Participantes com idade d?40 anos tiveram maior probabilidade de permanecerem sem evento e evolucao clinicadesfavoravel predominou entre pacientes BT. Monitoramento prolongado de hanseniaselesao-unica PB tratados com esquema minimo forneceu dados importantes sobremanejo clinico para os centros de referencia.