Título:	Effectiveness and safety of multidrug therapy containing clofazimine for paucibacillary leprosy and clarithromycin for rifampicin-resistant leprosy: a systematic review and meta-analysis
Autor(es):	Montezuma, Thais Vernal, Sebastian Andrade, Elaine Nascimento Brandão, Jurema Guerrieri Oliveira, Gustavo Laine Araújo de Gomes, Ciro Martins
Afiliação do autor:	Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo Ministério da Saúde do Brasil, Coordenação-Geral de Vigilância das Doenças em Eliminação Ministério da Saúde do Brasil, Coordenação-Geral de Vigilância das Doenças em Eliminação Universidade de Brasília, Programa de Pós-Graduação em Ciências Médicas Ministério da Saúde do Brasil, Coordenação-Geral de Vigilância das Doenças em Eliminação Universidade de Brasília, Programa de Pós-Graduação em Ciências Médicas Universidade de Brasília, Programa de Pós-Graduação em Patologia Molecular
Assunto:	Hanseníase Meta-análise Resistência a medicamentos
Data de publicação:	10-Mai-2023
Editora:	Frontiers
Referência:	MONTEZUMA, Thais et al. Effectiveness and safety of multidrug therapy containing clofazimine for paucibacillary leprosy and clarithromycin for rifampicin-resistant leprosy: a systematic review and meta-analysis. Frontiers in Medicine, v. 10, 2023. DOI: https://doi.org/10.3389/fmed.2023.1139304. Disponível em: https://www.frontiersin.org/articles/10.3389/fmed.2023.1139304/full. Acesso em: 25 out. 2023.
Abstract:	Introduction: The present study aimed to evaluate leprosy cure and relapse rates as primary outcomes related to two additional strategies for leprosy treatment: clofazimine for paucibacillary (PB) leprosy patients and clarithromycin for patients with rifampicin-resistant leprosy. Methods: We conducted two systematic reviews (protocols CRD42022308272 and CRD42022308260). We searched the PubMed, EMBASE, Web of Science, Scopus, LILACS, Virtual Health Library and Cochrane Library databases, registers of clinical trial databases and gray literature. We included clinical trials evaluating the addition of clofazimine to PB leprosy treatment and the use of clarithromycin for treating patients with rifampicin-resistant leprosy. Risk of bias (RoB) in randomized clinical trials was assessed by the RoB 2 tool and that in non-randomized clinical trials was assessed by the ROBINS-I tool; and the certainty of the evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. A meta-analysis of dichotomous outcomes was performed. Results: For clofazimine, four studies were included. Cure and relapse rates were not dierent with the addition of clofazimine to PB leprosy treatment and demonstrated very low certainty of evidence. For clarithromycin, six studies were included. Considerable heterogeneity resulted from the dierence between comparators, and studies showed no dierence in the assessed outcomes with the addition of clarithromycin to rifampicin-resistant leprosy treatment. Mild adverse events were reported for both drugs but did not significantly impact treatment. Discussion: The eectiveness of both drugs still needs to be determined. Adding clofazimine to PB leprosy treatment may reduce the repercussions of an incorrect operational classification with no apparent relevant side.
Unidade Acadêmica:	Faculdade de Medicina (FM)
Licença:	COPYRIGHT © 2023 Montezuma, Vernal, Andrade, Brandão, de Oliveira and Gomes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these term
DOI:	https://doi.org/10.3389/fmed.2023.1139304
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