Male Sex, Multibacillary Leprosy, and Leprosy Reactions Associated with Disability Risk

Cutis lepromatous leprosy pathological sample under light microscopy zoom in different areas
Study findings can guide the early identification of individuals at higher risk of developing physical disabilities and the development of targeted preventive interventions.

Male sex, multibacillary (MB) leprosy, leprosy reactions, and lepromatous presentation are associated with physical disability in patients with leprosy, study results published in JAMA Dermatology suggests.

In the study, researchers searched online databases for clinical trials published between 1988 and 2018, with a focus on “leprosy” and “physical disability” keywords. A total of 32 studies that assessed patients with the World Health Organization (WHO) leprosy disability grading system and provided the number of patients with vs without disability were included in the final meta-analysis. The analysis measured associations between patients’ clinical features and the presence of physical disability, based on the WHO disability classification.

Compared with female patients with leprosy, male patients with leprosy were significantly more likely to have physical disability (pooled odds ratio [OR], 1.66; 95% CI, 1.43-1.93; I2, 81.3%; P <.001). MB leprosy was associated with a 4-fold increased risk for physical disability vs paucibacillary leprosy (pooled OR, 4.32; 95% CI, 3.37-5.53; I2, 88.9%, P <.001).

A significant association was also found between the presence of leprosy reactions and physical disability (pooled OR, 2.43; 95% CI, 1.35-4.36; I2, 92.1%; P <.001). In addition, lepromatous leprosy was associated with a 5- to 12-fold higher odds of disability compared with borderline forms (pooled OR, 2.94; 95% CI, 1.72-5.02; I2, 92.2%; P <.001), tuberculoid leprosy (pooled OR, 5.85; 95% CI, 3.56-9.61; I2, 90.8%; P <.001), or indeterminate leprosy (pooled OR, 12.53; 95% CI, 6.34-24.76; I2, 86.4%; P <.001).

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Limitations of the meta-analysis included the inclusion of only studies that were observational and non-randomized in nature.

The various factors associated with physical disability in patients with leprosy “can guide the development of targeted interventions to identify individuals at early risk of physical disabilities and to inform education campaigns promoting early consultation to institute treatment for leprosy reactions and prevention of further physical disability,” the investigators noted.

Disclosure: None of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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de Paula HL, de Souza CDF, Silva SR, et al. Risk factors for physical disability in patients with leprosy: a systematic review and meta-analysis [published online August 7, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.1768