Does MDT increase the frequency and severity of lepra reactions?
The evidence available shows that there is a significant reduction in the frequency and severity of ENL (Type II) reactions in MB leprosy patients on MDT. It is possible that this is attributable to the anti-inflammatory effect of clofazimine. On the other hand, there seems to be a higher reporting of reversal reactions (Type I) in MB leprosy patients in the first year of MDT which then gradually declines. However, it is not clear whether this is because of more stringent follow-up of patients, which detects mild reactions that would otherwise have been missed, or whether there is a real increase in the incidence of reversal reactions.
