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.
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.
J Glob Antimicrob Resist. 2022 Sep;30:459-467. doi: 10.1016/j.jgar.2022.05.015. Epub 2022 May 26.
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.
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.
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.
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.
氨苯砜是治疗麻风病的重要药物之一。本研究旨在评估麻风分枝杆菌分离株对氨苯砜的耐药性，从而有助于实施更好的麻风消除控制策略。
系统检索 PubMed、Embase、Medline 和 Web of Science 中的文献。两名独立评审员根据系统评价和荟萃分析的首选报告项目（PRISMA）指南筛选文献，提取数据并评估偏倚风险。使用随机效应模型汇总耐药数据。根据跨采样时间、地区、研究人群（治疗状态、复发状态）和样本量进行亚组分析。
共纳入 30 项研究。荟萃分析结果显示，治疗后麻风患者的氨苯砜耐药率为 8%（95%置信区间 [CI]，6%-10%）。与未经治疗的新病例的原发性耐药率（汇总发生率，4%[95%CI，2%-5%]）相比，治疗病例（13%[95%CI 9%-16%]）发生继发性耐药，复发病例（26%[95%CI，18%-33%]）发生耐药。此外，单药治疗的耐药率明显高于复发病例的二氨二苯砜单药治疗。亚组分析显示，西太平洋地区患者的氨苯砜耐药率最高，2005 年后耐药率略有下降。按样本量大小分组，样本量在 100 例以下的组耐药率明显较高。
氨苯砜耐药与麻风复发和长期用药密切相关。氨苯砜单药治疗是复发病例耐药的重要原因之一。耐药性在世界不同人群和地区存在差异。
