A Review on Dapsone Hypersensitivity Syndrome Among Chinese Patients with an Emphasis on Preventing Adverse Drug Reactions with Genetic Testing

Abstract

Dapsone is a bactericidal and bacteriostatic against Mycobacterium leprae, a causative agent of leprosy. Dapsone is also applied in a range of medical fields because of its anti-inflammatory and immunomodulatory effects. Dapsone hypersensitivity syndrome (DHS) is a rare yet serious adverse drug reaction (ADR) caused by dapsone involving multiple organs. We performed a systematic review of published articles describing dapsone-induced hypersensitivity syndrome, including all Chinese articles and the latest literature available in online databases published between October 2009 and October 2015. We determined the prevalence, clinical characteristics, and mortality rate of DHS. Importantly, we also summarized the recent advances in genetic testing allowing prediction of ADRs. In an initial systematic electronic search, we retrieved 191 articles. Subsequently, these articles were further filtered and ultimately 84 articles (60 Chinese case reports, 21 non-Chinese articles, and three epidemiological studies) were selected, which included 877 patients. The prevalence of DHS among Chinese patients was 1.5% with a fatality rate of 9.6%. Early withdrawal of dapsone and appropriate treatment reduced the fatality rate. Most importantly, genetic screening for the HLA-B*13:01 allele among high-risk populations showed a significant utility as a useful genetic marker to DHS. In conclusion, this review discusses the epidemiological and clinical characteristics of DHS among Chinese patients, which may help physicians to understand this syndrome.

The Function of HLA-B*13:01 Involved in the Pathomechanism of Dapsone-Induced Severe Cutaneous Adverse Reactions

“…In addition to its use as an antibiotic in patients with leprosy and as primary prevention and prophylaxis in patients with AIDS, dapsone was also used for the treatment of chronic inflammatory dermatoses (see Supplementary Table S2 online). With the increasing use of dapsone in clinical practice, studies showed that the Asian population has a higher risk of developing dapsone-induced hypersensitivity reactions, with an incidence rate of more than 1% (Wang et al, 2017). In this study, we analyzed the clinical manifestations of dapsone SCAR in a cohort of eight patients who presented with clinical features characteristic of DRESS.…”

Amino Acid Variants of HLA-DRB1 Confer Susceptibility to Dapsone Hypersensitivity Syndrome in Addition to HLA-B*13:01

“…According to a recent review of published epidemiologic studies with patients from Asia, Europe, the United States, Australia, and Africa, total DHS prevalence was estimated to be about 1.4% (Lorenz et al, 2012). In Chinese leprosy patients, the prevalence of DHS is estimated at about 1.5%, with a mortality of 9.6%, based on our latest systematic review (Wang et al, 2017).…”

Cutaneous Adverse Drug Reaction: A Review of a Four-year Experience in a Tertiary Referral Hospital in Malaysia

“…Likewise, HLA-B*13:01 has been reported to be a predictor for dapsone-induced, drug-hypersensitivity syndromes among patients with leprosy. 15 HLA-B*13:01 has also been found among the three main indigenous groups in Peninsular Malaysia, namely the Temuan, Jehai, and Kensiu, with the Kensiu peoples having the highest allele frequency. 16 Whether this holds true for the indigenous peoples of the state of Pahang, resulting in higher CADR rates among them, requires further pharmacogenomic studies.…”