Immunotherapy in clinical practice - An evaluation

To The Editor,

The role of an immunomodulator as an adjunct to MDT in multibacillary leprosy has been the subject of investigation of late.

Clinical resolution, bacteriological decline and clearance of granuloma are reported to have been investigated, there have been several publications on the role of Mycobacterium w (M.w) in leprosy. Immunotherapy with this vaccine is also reported to decrease the incidence and severity of type 2 (ENL) reaction[1]. However, there have been reports on increased incidence of reversal reaction in multibacillary leprosy patients following MDT after immunotherapy with M.W.[2]

Studies[3] on viable bacilli have shown that in the MDT + immunotherapy group, no viable bacilli were demonstrable by mouse foot pad and ATP assays after 6 months, whereas in the control group viable bacilli could be detected up to 18 months and 2 years. In addition, Mw vaccine administered to standard MDT patients induces a lepromin response of a statistically significant higher magnitude than observed with MDT alone.[4]

While such well - documented studies are available, there have been instances where M w. vaccine has been used by a large number of the practising dermatologists and private practitioners.

A questionnaire study was prepared and distributed to about 300 practising physicians covering most parts of India. The emphasis in the questionnaire was on 1) whether they are using vaccine or not 2) using it occasionally or as a routine 3) what type of cases were given vaccine 4) side effects recorded and 5) overall observations on the efficacy of the vaccine.

Results

A total of 104 questionnaires were received as a feedback out of the total of about 300 questionnaires sent all over the country. Of the 104 respondents, 95 (91.03 %) were dermatologists. The rest were general medical practitioners and surgeons.

The response was analysed and the results are as follows:

Though it is difficult to draw firm conclusions from such a study, one could derive broad and crude observations. It can be observed from the above analysis through a quastionnaire method that a wide spectrum of patients was given this immunomodulator agent out of the total of 210 cases, 78% of the patients belonged to the multibacillary leprosy type. Of them, 632 of the cases betonged to the Borderline lepromatous and leprol leprosy types.Reactions were reported in 2 (3.37) of the patients only, which was surprisingly low in comparison with the reported findings. Eleven patients had ulcers at the site of the administration of the vaccine. The response was good in 61 cases while one case had a recurrence.

Overall, the study indicates that M.w vaccine as an agent in well received by the practising doctors and is free from any serious side effects.