A New Step in Postexposure Prophylaxis for Leprosy

This editorial examines recent progress in preventing leprosy through postexposure prophylaxis. While WHO-endorsed single-dose rifampin showed moderate protective effect (57%) in early trials, it lacked durability and proved less effective in high-risk household contacts. A new randomized trial by Wang et al. compared rifapentine, rifampin, and no treatment in household contacts. Rifapentine offered sustained protection over four years, outperforming rifampin. This finding is significant, especially in regions with low endemic levels of Mycobacterium leprae, where effective prophylaxis is urgently needed. Rifapentine, long used against tuberculosis, shows superior bactericidal activity in preclinical models and may revolutionize leprosy prevention. Challenges remain: identifying eligible contacts without violating privacy, preventing unnecessary treatment, and addressing resistance risks. Future steps include developing screening tools to identify latent infection and genetic susceptibility, and refining prophylactic regimens for broader application. This trial reenergizes leprosy prevention efforts and suggests rifapentine could shape next-generation multidrug therapy.

This editorial examines recent progress in preventing leprosy through postexposure prophylaxis. While WHO-endorsed single-dose rifampin showed moderate protective effect (57%) in early trials, it lacked durability and proved less effective in high-risk household contacts. A new randomized trial by Wang et al. compared rifapentine, rifampin, and no treatment in household contacts. Rifapentine offered sustained protection over four years, outperforming rifampin. This finding is significant, especially in regions with low endemic levels of Mycobacterium leprae, where effective prophylaxis is urgently needed. Rifapentine, long used against tuberculosis, shows superior bactericidal activity in preclinical models and may revolutionize leprosy prevention. Challenges remain: identifying eligible contacts without violating privacy, preventing unnecessary treatment, and addressing resistance risks. Future steps include developing screening tools to identify latent infection and genetic susceptibility, and refining prophylactic regimens for broader application. This trial reenergizes leprosy prevention efforts and suggests rifapentine could shape next-generation multidrug therapy.