Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da Universidade Federal do Ceará (UFC) |
Texto Completo: | http://www.repositorio.ufc.br/handle/riufc/12687 |
Resumo: | A simplified treatment in a single schema and shorter, rifampicin, dapsone and clofazimine for six months - UMDT for leprosy is being developed in Brazil to evaluate its effectiveness. Even if you will observe a recurrence percentage acceptable in terms of public health, with a good acceptance of treatment, the frequency of reactions is also an evaluator of the effectiveness of the scheme introduced. This study aims to characterize the pattern of occurrence and determinants of leprosy reactional episodes in patients treated with UMDT versus those treated with RMDT, regular treatment established by WHO / MS-BR in two reference centers for leprosy in Brazil in the period up to five years after discharge. This is an intervention study used to compare the reaction episodes between the two treatment groups. We evaluated 858 patients recruited between March 2007 and April 2012, of which 417 (48.6%) had reactions during the observation period. Patients were studied in separate clinical classification for its operating, paucibacillary (PB) or multibacillary (MB). The frequency of reaction time was analyzed using the survival function of the Kaplan-Meier method comparing the two study groups. The statistical test used was the log rank test. The multivariate modeling took into account the collected variables that could influence the occurrence of the reaction. There was no difference between treatment groups with regard to the occurrence of reactions for both PB, during the entire period of observation, and for the MB, from one year after six months of treatment. For MB, the UMDT patients have a higher risk of having reaction after stopping treatment. This risk tends to decrease when the RMDT patient end treatment at 12 months, and disappears after a year and a half of the beginning of the treatment of the two groups. If MB patients have had neuritis at enrollment, those who used the scheme UMDT had higher risk to present new reaction in the observed period than those who used the RMDT. Besides this difference, the present study showed a clear relationship between the R&J clinical form with the frequency of reactive episodes. Patients near the pole lepromatous, largest IB, showed more reaction. The BL forms are that more related to higher frequency of reactions. The results based on the occurrence of reactions allow recommendation of reducing regimen, proposing a single scheme with duration of 6 months for all patients diagnosed with leprosy, but with the recommendation of a special attention in those patients who begin treatment already presenting neuritis signals. |
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Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012Reactions in leprosy patients undergoing multidrugtherapy uniform (U- MDT ) and regular multidrugtherapy (R- MDT ) in Fortaleza and Manaus Reference Centers, 2007-2012HanseníaseReações BiológicasA simplified treatment in a single schema and shorter, rifampicin, dapsone and clofazimine for six months - UMDT for leprosy is being developed in Brazil to evaluate its effectiveness. Even if you will observe a recurrence percentage acceptable in terms of public health, with a good acceptance of treatment, the frequency of reactions is also an evaluator of the effectiveness of the scheme introduced. This study aims to characterize the pattern of occurrence and determinants of leprosy reactional episodes in patients treated with UMDT versus those treated with RMDT, regular treatment established by WHO / MS-BR in two reference centers for leprosy in Brazil in the period up to five years after discharge. This is an intervention study used to compare the reaction episodes between the two treatment groups. We evaluated 858 patients recruited between March 2007 and April 2012, of which 417 (48.6%) had reactions during the observation period. Patients were studied in separate clinical classification for its operating, paucibacillary (PB) or multibacillary (MB). The frequency of reaction time was analyzed using the survival function of the Kaplan-Meier method comparing the two study groups. The statistical test used was the log rank test. The multivariate modeling took into account the collected variables that could influence the occurrence of the reaction. There was no difference between treatment groups with regard to the occurrence of reactions for both PB, during the entire period of observation, and for the MB, from one year after six months of treatment. For MB, the UMDT patients have a higher risk of having reaction after stopping treatment. This risk tends to decrease when the RMDT patient end treatment at 12 months, and disappears after a year and a half of the beginning of the treatment of the two groups. If MB patients have had neuritis at enrollment, those who used the scheme UMDT had higher risk to present new reaction in the observed period than those who used the RMDT. Besides this difference, the present study showed a clear relationship between the R&J clinical form with the frequency of reactive episodes. Patients near the pole lepromatous, largest IB, showed more reaction. The BL forms are that more related to higher frequency of reactions. The results based on the occurrence of reactions allow recommendation of reducing regimen, proposing a single scheme with duration of 6 months for all patients diagnosed with leprosy, but with the recommendation of a special attention in those patients who begin treatment already presenting neuritis signals.Um tratamento simplificado em um único e mais curto esquema com rifampicina, dapsona e clofazimina durante seis meses - UMDT, para hanseníase está sendo desenvolvido no Brasil para avaliar sua efetividade. Mesmo que se venha observar um percentual de recidiva aceitável no ponto de vista da saúde pública, com uma boa aceitabilidade ao tratamento, a frequência dos episódios reacionais é também um avaliador da eficiência do esquema instituído. Este trabalho tem como objetivo caracterizar o padrão de ocorrência e fatores determinantes de episódios reacionais hansênicos em pacientes com hanseníase tratados com UMDT versus aqueles tratados com RMDT, o tratamento regular instituído pela OMS/MS-BR, em dois centros de referência em hanseníase no Brasil, no período de até cinco anos pós alta. Trata-se de um estudo de intervenção usado para comparar os episódios reacionais entre os dois grupos de tratamento. Foram avaliados 858 pacientes, recrutados entre março de 2007 e abril de 2012, dos quais 417 (48,6%) apresentaram reação no período de observação. Os pacientes foram estudados em separados por sua classificação clínica operacional, Paucibacilar (PB) ou Multibacilar (MB). A frequência de reação em tempo foi analisada usando a função de sobrevivência de Kaplan-Meier comparando os dois grupos de estudo. O teste estatístico utilizado foi o teste logrank. A modelagem multivariada levou em consideração as variáveis coletadas que poderiam influenciar na ocorrência da reação. Não se observou diferença entre os grupos de tratamento UMDT e RMDT no que se refere à ocorrência de reações tanto para os PB, em todo o período de observação, quanto para os MB, a partir de um ano após os seis meses do tratamento. Para os MB, os pacientes em UMDT apresentam um maior risco de ter reação após a interrupção do tratamento aos seis meses. Este risco tende a diminuir quando os pacientes em RMDT terminam seu tratamento, aos 12 meses, e desaparece depois de um ano e meio do início do tratamento dos dois grupos. Se os pacientes MB já apresentavam neurite no ato da inclusão, os que utilizavam o esquema UMDT tinham risco maior em apresentar nova reação no período observado que os que utilizavam o RMDT. Além desta diferença, o presente estudo revelou uma clara relação da forma clínica de R&J com a frequência dos episódios reacionais. A forma BL é que mais se relaciona com maior frequência das reações. Pacientes com formas mais perto do polo virchowiano, maiores IB, apresentaram mais reação. Os resultados baseados na ocorrência de reações permitem a recomendação da redução do esquema terapêutico, propondo-se um único esquema com duração de 6 meses para todo paciente diagnosticado com hanseníase, porém com a recomendação de uma atenção especial naqueles pacientes que já iniciam o tratamento apresentando sinais de neurite.Kerr, Ligia Regina Franco SansigoloAderaldo, Lúcio Cartaxo2015-06-09T13:22:59Z2015-06-09T13:22:59Z2013info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfADERALDO, L. C. Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012. 2013. 83 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2013.http://www.repositorio.ufc.br/handle/riufc/12687porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2022-03-21T14:09:50Zoai:repositorio.ufc.br:riufc/12687Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T18:22:20.697723Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false |
dc.title.none.fl_str_mv |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 Reactions in leprosy patients undergoing multidrugtherapy uniform (U- MDT ) and regular multidrugtherapy (R- MDT ) in Fortaleza and Manaus Reference Centers, 2007-2012 |
title |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 |
spellingShingle |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 Aderaldo, Lúcio Cartaxo Hanseníase Reações Biológicas |
title_short |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 |
title_full |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 |
title_fullStr |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 |
title_full_unstemmed |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 |
title_sort |
Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012 |
author |
Aderaldo, Lúcio Cartaxo |
author_facet |
Aderaldo, Lúcio Cartaxo |
author_role |
author |
dc.contributor.none.fl_str_mv |
Kerr, Ligia Regina Franco Sansigolo |
dc.contributor.author.fl_str_mv |
Aderaldo, Lúcio Cartaxo |
dc.subject.por.fl_str_mv |
Hanseníase Reações Biológicas |
topic |
Hanseníase Reações Biológicas |
description |
A simplified treatment in a single schema and shorter, rifampicin, dapsone and clofazimine for six months - UMDT for leprosy is being developed in Brazil to evaluate its effectiveness. Even if you will observe a recurrence percentage acceptable in terms of public health, with a good acceptance of treatment, the frequency of reactions is also an evaluator of the effectiveness of the scheme introduced. This study aims to characterize the pattern of occurrence and determinants of leprosy reactional episodes in patients treated with UMDT versus those treated with RMDT, regular treatment established by WHO / MS-BR in two reference centers for leprosy in Brazil in the period up to five years after discharge. This is an intervention study used to compare the reaction episodes between the two treatment groups. We evaluated 858 patients recruited between March 2007 and April 2012, of which 417 (48.6%) had reactions during the observation period. Patients were studied in separate clinical classification for its operating, paucibacillary (PB) or multibacillary (MB). The frequency of reaction time was analyzed using the survival function of the Kaplan-Meier method comparing the two study groups. The statistical test used was the log rank test. The multivariate modeling took into account the collected variables that could influence the occurrence of the reaction. There was no difference between treatment groups with regard to the occurrence of reactions for both PB, during the entire period of observation, and for the MB, from one year after six months of treatment. For MB, the UMDT patients have a higher risk of having reaction after stopping treatment. This risk tends to decrease when the RMDT patient end treatment at 12 months, and disappears after a year and a half of the beginning of the treatment of the two groups. If MB patients have had neuritis at enrollment, those who used the scheme UMDT had higher risk to present new reaction in the observed period than those who used the RMDT. Besides this difference, the present study showed a clear relationship between the R&J clinical form with the frequency of reactive episodes. Patients near the pole lepromatous, largest IB, showed more reaction. The BL forms are that more related to higher frequency of reactions. The results based on the occurrence of reactions allow recommendation of reducing regimen, proposing a single scheme with duration of 6 months for all patients diagnosed with leprosy, but with the recommendation of a special attention in those patients who begin treatment already presenting neuritis signals. |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013 2015-06-09T13:22:59Z 2015-06-09T13:22:59Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
ADERALDO, L. C. Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012. 2013. 83 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2013. http://www.repositorio.ufc.br/handle/riufc/12687 |
identifier_str_mv |
ADERALDO, L. C. Reações em pacientes com hanseníase submetidos a multidrogaterapia uniforme (U-MDT) e multidrogaterapia regular (R-MDT) em Centros de Referência de Fortaleza e Manaus, 2007 a 2012. 2013. 83 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2013. |
url |
http://www.repositorio.ufc.br/handle/riufc/12687 |
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por |
language |
por |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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reponame:Repositório Institucional da Universidade Federal do Ceará (UFC) instname:Universidade Federal do Ceará (UFC) instacron:UFC |
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Universidade Federal do Ceará (UFC) |
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UFC |
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UFC |
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Repositório Institucional da Universidade Federal do Ceará (UFC) |
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Repositório Institucional da Universidade Federal do Ceará (UFC) |
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Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC) |
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bu@ufc.br || repositorio@ufc.br |
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