Krismawati Hana, Harianja Maria, Oktavian Antonius, Bøgh Claus, Ataupah Messe R, Laiskodat Ruth D, Pongtiku Arry, Geluk Annemieke, Baird J Kevin, Hamers Raph L, Soebono Hardyanto, Walker Stephen L, Grijsen Marlous L
Center of Health System and Strategy, Ministry of Health, Jakarta, Indonesia.
Sumba Foundation, Sumba, Indonesia.
Lancet Reg Health Southeast Asia. 2025 Feb 26;34:100555. doi: 10.1016/j.lansea.2025.100555. eCollection 2025 Mar.
Leprosy is effectively treated with multi-drug therapy (MDT), a regimen containing three antibiotic drugs, including dapsone - a sulfone drug associated with potentially life-threatening adverse drug reactions. Specifically, dapsone hypersensitivity syndrome (DHS), linked to HLA-B∗13:01 polymorphism, and hemolytic anemia associated with glucose-6-phosphate dehydrogenase deficiency (G6PDd). Both of these pharmacogenetic polymorphisms can be prevented through diagnostic screening before MDT initiation averting potential complications. However, in leprosy-endemic areas like Indonesia, access to these tests often remains inaccessible due to high costs and limited laboratory capacity. Additionally, alternative dapsone-sparing treatment regimens are usually unavailable or unaffordable, restraining individuals onto suboptimal dual-therapy with rifampicin and clofazimine, which has uncertain efficacy. We raise concerns regarding the safety of dapsone-containing MDT without routine pharmacogenetic screening and the unavailability of alternative regimens. We call for action to address persisting global health inequities in care delivery, ensuring all individuals receive the safest and most effective leprosy treatment options.
麻风病可通过多药联合治疗（MDT）得到有效治疗，该疗法包含三种抗生素药物，其中包括氨苯砜——一种与潜在危及生命的药物不良反应相关的砜类药物。具体而言，与HLA - B∗13:01多态性相关的氨苯砜超敏反应综合征（DHS），以及与葡萄糖 - 6 - 磷酸脱氢酶缺乏症（G6PDd）相关的溶血性贫血。在开始MDT之前，通过诊断性筛查可以预防这两种药物遗传学多态性，避免潜在并发症。然而，在印度尼西亚等麻风病流行地区，由于成本高昂和实验室能力有限，通常无法进行这些检测。此外，通常无法获得或负担不起不含氨苯砜的替代治疗方案，这使得患者只能接受次优的利福平与氯法齐明联合治疗，其疗效尚不确定。我们对在没有常规药物遗传学筛查的情况下使用含氨苯砜的MDT的安全性以及替代方案的不可用性表示担忧。我们呼吁采取行动，解决在医疗服务方面持续存在的全球健康不平等问题，确保所有患者都能获得最安全、最有效的麻风病治疗方案。
