02401nas a2200421   4500000000100000008004100001260001600042653002700058653001200085653003800097653002000135653001500155653001400170653001200184653003700196653001800233653002200251653002100273100001700294700001500311700001500326700001200341700001500353700001700368700001500385700001200400700001300412700001400425700001400439700001400453700001500467245013400482856007500616300000600691490000700697520126100704022001401965       2025                            d  bElsevier BV10aAcute hemolytic anemia10aDapsone10aDapsone hypersensitivity syndrome10aG6PD deficiency10aHLA-B13:0110aIndonesia10aLeprosy10aLow- and middle-income countries10aMorbus Hansen10aMultidrug therapy10aPharmacogenetics1 aKrismawati H1 aHarianja M1 aOktavian A1 aBøgh C1 aAtaupah MR1 aLaiskodat RD1 aPongtiku A1 aGeluk A1 aBaird JK1 aHamers RL1 aSoebono H1 aWalker SL1 aGrijsen ML00aChallenges associated with dapsone for leprosy treatment in Indonesia - urgent need for access to alternative antimicrobial drugs  uhttps://www.thelancet.com/action/showPdf?pii=S2772-3682%2825%2900026-5  a50 v343 a<p>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).</p>

<p>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.</p>
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