Chemoprophylaxis in contacts of patients with leprosy: systematic review and meta-analysis
Chemoprophylaxis in contacts of patients with leprosy: systematic review and meta-analysis
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DOI：
10.1590/s1020-49892009001000009
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发表时间：
2009-10-01
期刊：
影响因子：
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通讯作者：
Téllez, Diana
中科院分区：
文献类型：
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作者：
Reveiz, Ludovic;Buendía, Jefferson A.;Téllez, Diana
Objective.识别并总结评估化学预防对新诊断麻风患者接触者的有效性的随机临床试验（RCT）。所有研究均摘自Medline（PubMed 1966年至2008年11月）、科克伦对照试验注册库（2008年第3号）、LILACS（1982年至2008年11月）和Scirus（2008年11月）。还进行了手动检索和检索评估文章的交叉引用。根据科克伦协作网提出的方法评估RCT的偏倚风险。主要的结局指标是麻风病患者（原发病例）接触者中麻风病（继发病例）的诊断。检索到320篇参考文献，其中纳入并评价了7项RCT，共66311例受试者。随机对照试验的综合结果显示，与安慰剂相比，药物预防治疗更有效，随访2-4年（6项随机对照试验，66107例受试者，相对风险（RR）0.59，95%置信区间（CI）0.50-0.70，I-2 = 0（I-2描述了异质性引起的研究间总变异百分比））。单剂量利福平（21 711例受试者，RR 0.43，95% CI 0.28-0.67，需要治疗的人数为285），每周一次或两次氨苯砜，至少持续2年（3项随机对照试验，43137例受试者，RR 0.60，95%CI 0.48-0.76，I-2 = 0），以及acedapsone，每10周一次，持续7个月（2项随机对照试验，1 259例受试者，RR 0.49，95%CI 0.33-0.72，I-2 = 0）在预防继发性麻风病例方面显著上级安慰剂。化学预防可有效降低麻风病患者接触者的发病率。
Objective. To identify and summarize randomized clinical trials (RCTs) that assessed the effectiveness of chemoprophylaxis to prevent leprosy in contacts of patients newly diagnosed with the disease.Methods. All studies were extracted from Medline (PubMed 1966 to November 2008), the Cochrane Controlled Trials Register (number 3 2008), LILACS (1982 to November 2008), and Scirus (November 2008). Manual searches and searches of crossed references of assessed articles were also done. RCTs' risk of bias was assessed according to the methodology proposed by the Cochrane Collaboration. The main outcome measure was diagnosis of leprosy (secondary cases) in contacts of patients with the disease (primary cases).Results. The search identified 320 references, from which 7 RCTs with a total of 66 311 participants were included and evaluated. The combined results from the RCTs favored chemoprophylaxis to placebo with 2-4 years of follow-up (6 RCTs, 66 107 participants, relative risk (RR) 0.59, 95% confidence interval (CI) 0.50-0.70, I-2 = 0 (I-2 describes percent total variation across studies caused by heterogeneity)). Single-dose rifampicin (21 711 participants, RR 0.43, 95% CI 0.28-0.67, number needed to treat 285), dapsone once or twice weekly for at least 2 years (3 RCTs, 43 137 participants, RR 0.60, 95% CI 0.48-0.76, I-2 = 0), and acedapsone every 10 weeks for 7 months (2 RCTs, 1 259 participants, RR 0.49, 95% CI 0.33-0.72, I-2 = 0) were significantly superior to placebo in preventing secondary cases of leprosy.Conclusion. Chemoprophylaxis is effective in lowering the incidence of leprosy in contacts of patients diagnosed with the disease.