OBJECTIVE: The World Health Organization (WHO) recommends multidrug therapy (MDT) with rifampicin, dapsone, and clofazimine for treating leprosy, which based on very low-quality evidence. Here we performed a network meta-analysis (NMA) to produce quantitative evidence to strengthen current WHO recommendations.
METHOD: All studies were obtained from Embase and PubMed from the date of establishment to October 9, 2021. Data were synthesized with frequentist random-effects network meta-analyses. Outcomes were assessed using odds ratios (ORs), 95% confident intervals (95% CIs) and P score.
RESULTS: Sixty controlled clinical trials and 9256 patients were included. MDT was effective (range of OR: 1·06-1255584·25) for treating leprosy and multibacillary leprosy. Six treatments (Range of OR: 1.199-4.50) were more effective than MDT. Clofazimine (P score=0.9141) and dapsone+rifampicin (P score=0·8785) were effective for treating type 2 leprosy reaction. There were no significant differences in the safety of any of the tested drug regimens.
CONCLUSIONS: The WHO MDT is effective for treating leprosy and multibacillary leprosy, but it may not be effective enough. Pefloxacin and ofloxacin may be good adjunct drugs for increasing MDT efficacy. Clofazimine and dapsone+rifampicin can be used in the treatment of a type 2 leprosy reaction. Single drug regimens are not efficient enough to treat leprosy, multibacillary leprosy, or a type 2 leprosy reaction.
AVAILABILITY OF DATA AND MATERIALS: All data generated or analysed during this study are included in this published article [and its supplementary information files].
BT - The Journal of infection C1 - https://www.ncbi.nlm.nih.gov/pubmed/36796681 DA - 02/2023 DO - 10.1016/j.jinf.2023.02.019 J2 - J Infect LA - eng N2 -OBJECTIVE: The World Health Organization (WHO) recommends multidrug therapy (MDT) with rifampicin, dapsone, and clofazimine for treating leprosy, which based on very low-quality evidence. Here we performed a network meta-analysis (NMA) to produce quantitative evidence to strengthen current WHO recommendations.
METHOD: All studies were obtained from Embase and PubMed from the date of establishment to October 9, 2021. Data were synthesized with frequentist random-effects network meta-analyses. Outcomes were assessed using odds ratios (ORs), 95% confident intervals (95% CIs) and P score.
RESULTS: Sixty controlled clinical trials and 9256 patients were included. MDT was effective (range of OR: 1·06-1255584·25) for treating leprosy and multibacillary leprosy. Six treatments (Range of OR: 1.199-4.50) were more effective than MDT. Clofazimine (P score=0.9141) and dapsone+rifampicin (P score=0·8785) were effective for treating type 2 leprosy reaction. There were no significant differences in the safety of any of the tested drug regimens.
CONCLUSIONS: The WHO MDT is effective for treating leprosy and multibacillary leprosy, but it may not be effective enough. Pefloxacin and ofloxacin may be good adjunct drugs for increasing MDT efficacy. Clofazimine and dapsone+rifampicin can be used in the treatment of a type 2 leprosy reaction. Single drug regimens are not efficient enough to treat leprosy, multibacillary leprosy, or a type 2 leprosy reaction.
AVAILABILITY OF DATA AND MATERIALS: All data generated or analysed during this study are included in this published article [and its supplementary information files].
PY - 2023 T2 - The Journal of infection TI - Seventy years of evidence on the efficacy and safety of drugs for treating leprosy: a network meta-analysis. SN - 1532-2742 ER -