The adverse drug effects of dapsone therapy in leprosy: a systematic review

Hilder, Robin; Lockwood, Diana N. J.

doi:10.47276/lr.91.3.232

Cited by 10 publications

(3 citation statements)

References 28 publications

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“…Hilder and Lockwood (2020), in their systematic review, recommended that patients should have laboratory examinations when starting MDT with repeated assessments at 4–8-week intervals. In resource-constrained environments, particularly in low and middle-income countries, this model could provide guidance to identify patients in need of more frequent monitoring [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Development of a multivariate predictive model for dapsone adverse drug events in people with leprosy under standard WHO multidrug therapy

de Araujo,

Hacker,

Pinheiro

et al. 2024

PLoS Negl Trop Dis

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Background The occurrence of adverse drug events (ADEs) during dapsone (DDS) treatment in patients with leprosy can constitute a significant barrier to the successful completion of the standardized therapeutic regimen for this disease. Well-known DDS-ADEs are hemolytic anemia, methemoglobinemia, hepatotoxicity, agranulocytosis, and hypersensitivity reactions. Identifying risk factors for ADEs before starting World Health Organization recommended standard multidrug therapy (WHO/MDT) can guide therapeutic planning for the patient. The objective of this study was to develop a predictive model for DDS-ADEs in patients with leprosy receiving standard WHO/MDT. Methodology This is a case-control study that involved the review of medical records of adult (≥18 years) patients registered at a Leprosy Reference Center in Rio de Janeiro, Brazil. The cohort included individuals that received standard WHO/MDT between January 2000 to December 2021. A prediction nomogram was developed by means of multivariable logistic regression (LR) using variables. The Hosmer–Lemeshow test was used to determine the model fit. Odds ratios (ORs) and their respective 95% confidence intervals (CIs) were estimated. The predictive ability of the LRM was assessed by the area under the receiver operating characteristic curve (AUC). Results A total of 329 medical records were assessed, comprising 120 cases and 209 controls. Based on the final LRM analysis, female sex (OR = 3.61; 95% CI: 2.03–6.59), multibacillary classification (OR = 2.5; 95% CI: 1.39–4.66), and higher education level (completed primary education) (OR = 1.97; 95% CI: 1.14–3.47) were considered factors to predict ADEs that caused standard WHO/MDT discontinuation. The prediction model developed had an AUC of 0.7208, that is 72% capable of predicting DDS-ADEs. Conclusion We propose a clinical model that could become a helpful tool for physicians in predicting ADEs in DDS-treated leprosy patients.

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Section: Discussionmentioning

confidence: 99%

Development of a multivariate predictive model for dapsone adverse drug events in people with leprosy under standard WHO multidrug therapy

de Araujo,

Hacker,

Pinheiro

et al. 2024

PLoS Negl Trop Dis

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“…A smaller number of patients will develop Dapsone Hypersensitivity Syndrome with a mortality of up to 10%. 6 Clofazimine causes significant problems when it accumulates in the skin, causing an ichthyosis. More significant are the social problems cause by clofazimine pigmentation since it shows that a patient is taking antileprosy drugs and so breaks confidentiality about treatment of leprosy.…”

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confidence: 99%

Leprosy workers in the 21st century need to focus on “Better knowledge, Early diagnosis and Improved care”, the theme of the International Leprosy Congress in Hyderabad, 2022

Lockwood

Darlong²

2023

LEPROSY

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We report on the 21st International Leprosy Congress held in Hyderabad in November 2022, with the theme "Better Knowledge -Early diagnosis -Improved care". It was hosted by the International Leprosy Association, with support from the Indian Association of Leprologists; the Indian Association of Dermatologists, Venereologists and Leprologists; and the Indian National Elimination Programme, as well as the World Health Organisation and ILEP members.This hybrid Congress had both physical and virtual sessions with large number of symposia, lead talks, paper presentations, poster and short video presentations.There were 8 plenary sessions, 72 faculty abstracts, 423 oral papers, 20 papers given different awards and 457 e-posters. Topics covered were clinical aspects (234), diagnostics (6) disability and rehabilitation (96) epidemiology and control (198) laboratory aspects (140), miscellaneous (49), programmatic management (8), rehabilitation, both social and physical (6), social aspects (132), surgery (1) and therapeutics (57). There were 1050 physical delegates and 450 people attended electronically. Delegates came from 56 countries with an age range of 25-75 years.The abstracts are available at https://ilc.abstracts.mediknit.org/ (https://doi.org/10.57202/ ILC2022).

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“…20 A systematic review of dapsone-associated adverse effects showed that dapsone hypersensitivity syndrome and haemolysis associated with dapsone are under-reported. 21 Monitoring patients' haemoglobin before and after starting treatment would detect this. Clofazimine causes increased skin pigmentation, which can be a distressing adverse effect of treatment with negative impacts on self-esteem and adherence to treatment.…”

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confidence: 99%

Current leprosy multi-drug treatment duration for MB patients (12 months) produces good clinical outcomes over many years

Lockwood¹,

Butlin

Penna

2021

LEPROSY

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There have been recent discussions in the leprosy world by people concerned that the current 12 months multi-drug treatment (MDT) regimens for multibacillary leprosy patients are inadequate and contribute to poor control of the disease. We argue here that recent studies show that the current regimens are good for treating the infection in individual patients and do not need extending. Patients with an initial high BI do not need longer treatments. 1,2 Clinicians and patients should have a long time frame for patient improvement which can be years after treatment has finished. The WHO sponsored multi-drug regimens were introduced in 1982 and have been regularly altered since then. 3,4 Initially patients with MB leprosy were treated until their slit skin smears were negative. In 1994 the WHO Expert Committee recommended fixed duration treatment of 24 months for MB patients. This was reduced to 12 months in 1998. 5,6 These decisions were not supported by data from prospective drug trials. Fortunately, the relapse rate in leprosy has been very low, with about 1% of patients relapsing with a new study from Brazil showing a low relapse rate after treatment with 12 months MDT with a 12 year follow up. 1,7,8 An early study in Ethiopia had a zero relapse rate after 24 months treatment. 9 Patient outcomes after leprosy multi-drug treatment can be assessed by three measures: (1) Clinical improvement of the lesions, (2) Fall in the Bacterial Index and (3) relapse rate.Clinical improvement of skin lesions is variable. This is partly due to the ongoing inflammation in the lesions which is part of the clinical disease. Some patients' skin lesions resolve

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The adverse drug effects of dapsone therapy in leprosy: a systematic review

Cited by 10 publications

References 28 publications

Development of a multivariate predictive model for dapsone adverse drug events in people with leprosy under standard WHO multidrug therapy

Development of a multivariate predictive model for dapsone adverse drug events in people with leprosy under standard WHO multidrug therapy

Leprosy workers in the 21st century need to focus on “Better knowledge, Early diagnosis and Improved care”, the theme of the International Leprosy Congress in Hyderabad, 2022

Current leprosy multi-drug treatment duration for MB patients (12 months) produces good clinical outcomes over many years

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