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TOPLINE:

Monthly rifampin-moxifloxacin-minocycline (RMM) therapy was associated with a lower risk for type 1 immunologic reactions than multidrug therapy (MDT) in patients with leprosy (Hansen disease [HD]) in a study.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 111 patients with biopsy- and polymerase chain reaction-confirmed HD treated at a Miami HD clinic between October 2010 and November 2025.
• The mean age of the patients was 52 years (range, 15-85 years); 62% were male; 40%-43% were Hispanic, 52%-56% were non-Hispanic, 9%-12% were Black or African American, and 84%-88% were White; 70% had multibacillary disease.
• Patients received either World Health Organization-recommended MDT (monthly rifampin and daily dapsone and clofazimine; n = 86, 77%), the global gold standard treatment, or monthly RMM therapy (n = 25, 23%); 11 (10%) patients later switched from MDT to monthly RMM (a single dose of rifampin, moxifloxacin, and minocycline). RMM has been recommended by the National Hansen’s Disease Program since 2025, although studies are limited.
• The primary outcomes were the occurrence of a type 1 reaction (which often leads to disability) or erythema nodosum leprosum (ENL).

TAKEAWAY:

• Type 1 reactions occurred in 56% of patients with a median onset of 2 months after initiating antibiotics, and ENL occurred in 33% of patients with a median onset of 1 month.
• Patients who received RMM therapy had a significantly lower risk for a type 1 reaction than those who received MDT (odds ratio [OR], 0.28; P = .047).
• Monthly RMM therapy was not associated with the risk for ENL compared with MDT (OR, 0.89, P = .86), and no significant differences were observed in the frequency of immunologic reactions, duration of symptoms, or immunosuppressant use.
• Borderline disease status was associated with an increased risk for type 1 reactions (OR, 8.48; P < .001) compared with either tuberculoid or lepromatous disease. Borderline lepromatous or lepromatous leprosy disease status was associated with an increased risk for ENL (OR, 11.9; P < .001) compared with other disease types.

IN PRACTICE:

“This study was the first to demonstrate a significantly lower risk of T1R [type 1 reactions] in patients receiving RMM vs MDT and no significant difference in ENL risk,” the authors of the study wrote. “While prospective, head-to-head trials are needed to establish the effectiveness and microbiological outcomes of RMM therapy in multibacillary disease,” they added, the study “provided some reassurance regarding its decreased risk of T1R, although this finding must be interpreted with caution given the limited sample size.”

SOURCE:

The study was led by Peyton V. Warp, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, and was published online as a research letter on June 3 in JAMA Dermatology.

LIMITATIONS:

Study limitations included the small sample size, the small number of events in the RMM therapy group, the retrospective design, the single-center scope, and a shorter follow-up period.

DISCLOSURES:

The authors did not disclose any funding information. One author disclosed receiving personal fees from argenx, Johnson & Johnson, and Biogen for serving as a principal investigator, and from Medicines Development for Global Health for serving as a data safety monitoring board member, and also disclosed being an associate editor of JAMA Dermatology but was not involved in any decisions regarding the review of the manuscript or its acceptance. No other disclosures were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.