Risk factors for Dapsone Resistance in Leprosy Patients: A systematic meta-analysis
: 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 implement 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 PRISMA guidelines, extracted data, and evaluated the risk of bias. Drug resistance data was pooled using the random effect 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 includes. The results of meta-analysis showed that the dapsone resistance rate of leprosy patients after treatment was 8% [95% CI, 6% to 10%]. Compared to the rates of primary resistance of new cases without treatment therapy (pooled incidence, 4% [95% CI, 2% to 5%]), treatment cases (13% [95% CI 9% to 16%]) had secondary resistance, and relapse cases (26% [95% CI, 18% to 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 Western Pacific has 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 were 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 reason for drug resistance in relapsed cases. Differences in drug resistance in different populations and different regions of the world.