From the Guidelines
The risk of drug-induced hepatitis in patients with leprosy is significant, particularly with the use of certain antituberculosis medications such as INH, RIF, and PZA, which are commonly used to treat tuberculosis, a common comorbidity in leprosy patients.
Risk Factors
- Preexisting liver disease: Patients with preexisting liver disease are at a higher risk of developing drug-induced hepatitis when taking hepatotoxic medications like INH, RIF, and PZA 1.
- Hepatotoxic medications: INH, RIF, and PZA can cause drug-induced liver injury (DILI), which is suspected when the ALT level is ≥3 times the upper limit of normal in the presence of hepatitis symptoms, or ≥5 the upper limit of normal in the absence of symptoms 1.
Monitoring and Management
- Frequent clinical and laboratory monitoring: Patients with preexisting liver disease should undergo frequent clinical and laboratory monitoring to detect drug-induced hepatic injury 1.
- Discontinuation of hepatotoxic medications: If drug-induced hepatitis occurs, hepatotoxic medications like INH, RIF, and PZA should be stopped immediately, and the patient should be evaluated carefully to exclude other causes of abnormal liver function tests 1.
Treatment Considerations
- Alternative treatment regimens: For patients with severe liver disease, alternative treatment regimens with fewer hepatotoxic agents, such as RIF plus EMB, may be considered 1.
- Close monitoring: Close monitoring of serum AST and bilirubin levels, as well as symptom review, is essential in managing patients with drug-induced hepatitis 1.
From the Research
Risk of Drug-Induced Hepatitis in Patients with Leprosy
- The risk of drug-induced hepatitis in patients with leprosy is a significant concern, particularly with the use of certain medications such as thioamides and rifampin 2, 3.
- A study published in 1983 found a 13% incidence of hepatitis among 54 cases of multibacillary leprosy treated with a combination of dapsone, rifampin, and a thioamide 2.
- Another study published in 1985 found that the use of prothionamide in combination with dapsone and rifampin resulted in higher hepatotoxicity compared to a regimen that used clofazimine instead of prothionamide 3.
- The risk of hepatitis may be increased in patients with leprosy who are also infected with hepatitis B virus, as this can alter the host immune system response and lead to poorer disease outcomes 4, 5, 6.
- A study published in 2014 found a strong association between leprosy and hepatitis B virus infection, particularly in patients with lepromatous leprosy 6.
- The use of medications that are potentially hepatotoxic, such as thioamides and rifampin, should be carefully monitored in patients with leprosy, particularly those who are also infected with hepatitis B virus 2, 3.