Risk factors for dapsone resistance in leprosy patients: a systematic meta-analysis

Ziwei Wu; Chen Wang; Zhenzhen Wang; Ying Shi; Haiqing Jiang; Hongsheng Wang

doi:10.1016/j.jgar.2022.05.015

Risk factors for dapsone resistance in leprosy patients: a systematic meta-analysis

J Glob Antimicrob Resist. 2022 Sep:30:459-467. doi: 10.1016/j.jgar.2022.05.015. Epub 2022 May 26.

Authors

Ziwei Wu¹, Chen Wang², Zhenzhen Wang³, Ying Shi³, Haiqing Jiang³, Hongsheng Wang⁴

Affiliations

¹ Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Molecular and Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
² Jiangsu Key Laboratory of Molecular and Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
³ Jiangsu Key Laboratory of Molecular and Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
⁴ Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Molecular and Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China. Electronic address: whs33@vip.sina.com.

PMID: 35643395
DOI: 10.1016/j.jgar.2022.05.015

Abstract

Objectives: Dapsone is one of the important drugs in the treatment of leprosy. The present study aims to evaluate the resistance of Mycobacterium leprae isolates to dapsone, in turn assisting in implementing better control strategies for leprosy elimination.

Methods: A systematic literature search was conducted in PubMed, Embase, Medline, and Web of Science. Two independent reviewers selected the literature according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), extracted data, and evaluated the risk of bias. Drug resistance data were pooled using the random-effects model. Subgroup analysis was performed based on across sampling time, region, study population (treatment status, relapses status), and sample size.

Results: A total of 30 studies were included. The results of meta-analysis showed that the dapsone resistance rate of leprosy patients after treatment was 8% (95% confidence interval [CI], 6%-10%). Compared to the rates of primary resistance of new cases without treatment therapy (pooled incidence, 4% [95% CI, 2%-5%]), treatment cases (13% [95% CI 9%-16%]) had secondary resistance, and relapse cases (26% [95% CI, 18%-33%]) had drug resistance. In addition, the drug resistance rate of monotherapy was significantly increased than that of relapsed patients treated with diamino-diphenylsulfone monotherapy. Subgroup analysis showed that the patients in the Western Pacific have the highest dapsone resistance, and the resistance to dapsone was slightly lower after 2005. For sample size, the rate in the group under 100 samples was significantly higher than in the other.

Conclusion: Dapsone resistance is closely related to leprosy relapse and long-term drug use. Dapsone monotherapy is one of important reasons for drug resistance in relapsed cases. Drug resistance varies among different populations and regions of the world.

Keywords: Antimicrobial resistance; Dapsone; Drug resistance; Mycobacterium leprae.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Dapsone* / pharmacology
Dapsone* / therapeutic use
Humans
Leprosy* / drug therapy
Leprosy* / microbiology
Mycobacterium leprae
Recurrence
Risk Factors

Substances

Dapsone