TERAPI ALTERNATIF REAKSI KUSTA
Abstrak
Kusta merupakan infeksi kronik yang disebabkan oleh Mycobacterium leprae. Dalam perjalanan penyakit kusta dapat terjadi episode akut yang disebut reaksi kusta. Menurut World Health Organization (WHO), pemberian kortikosteroid merupakan terapi lini pertama reaksi kusta, namun kortikosteroid memiliki berbagai efek samping jika digunakan dalam jangka panjang. Banyak pula kasus reaksi kusta berulang yang resisten atau bergantung terhadap kortikosteroid, sehingga terapi alternatif dapat menjadi pilihan untuk kasus-kasus tersebut. Terapi alternatif yang kami jabarkan adalah pentoksifilin, siklosporin, azatioprin, metotreksat dan agen biologik (apremilast, Inhibitor TNF- -α dan IL-17). Artikel ini akan memaparkan indikasi hingga efek samping dari terapi alternatif untuk reaksi kusta. Studi mengenai terapi alternatif masih cukup terbatas (seperti studi kasus, case series, studi randomized control trial dalam skala kecil). Namun, didapatkan hasil yang cukup menjanjikan. Metotreksat merupakan terapi alternatif yang unggul dikarenakan memiliki hasil yang menjanjikan berdasarkan beberapa studi kasus yang telah dilakukan dan saat ini tengah dilakukan studi multi-senter randomized control trial dalam skala besar. Maka dari itu, masih diperlukan studi lebih lanjut mengenai penggunaan terapi alternatif pada reaksi kusta dan penggunaanya saat ini perlu dilakukan dengan penuh pertimbangan dan hati-hati.
References
1. Salgado CG, Brito ACd, Salgado UI, Spencer JS. Chapter 159: Leprosy. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 2892-924.
2. Moloo A. Leprosy: new data show steady decline in new cases. 2019. [Cited 18 February 2021]. Available from: https://www.who.int/neglected_diseases/news/Leprosy-new-data-show-steady-decline-in-new-cases/en/.
3. Pemmaraju VR. Leprosy - Number of new leprosy cases. 2020. [Cited 18 February 2021]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-new-leprosy-cases.
4. Widiatma RR, Prakoeswa CRS. Studi Retrospektif: Reaksi Kusta Tipe 1. Berkala Ilmu Kesehatan Kulit dan Kelamin. 2019;31(2):144-9.
5. RSUP dr. Sitanala Tangerang. Laporan tahunan instalasi rekam medik. 2020.
6. Polycarpou A, Walker SL, Lockwood DN. A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum. Front Immunol. 2017;8:233.
7. World Health Organization. Leprosy hansen disease: management of reactions and prevention of disabilities: technical guidance. 2020.
8. Wisnu IM, Sjamsoe-Daili ES, Menaldi SL. Kusta. Dalam: Menaldi SL, Bramono K, Indriatmi W, penyunting. Ilmu Penyakit Kulit dan Kelamin. Edisi ke-7. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2016. h. 83-102.
9. Cogen AL, Lebas E, De Barros B, Harnisch JP, Faber WR, Lockwood DN, dkk. Biologics in Leprosy: A Systematic Review and Case Report. Am J Trop Med Hyg. 2020;102(5):1131-6.
10. Fischer M. Leprosy - an overview of clinical features, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017;15(8):801-27.
11. Costa PdSS, Fraga LR, Kowalski TW, Daxbacher ELR, Schuler-Faccini L, Vianna FSL. Erythema Nodosum Leprosum: Update and challenges on the treatment of a neglected condition. Acta Tropica. 2018;183:134-41.
12. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan. Pedoman Nasional Program Pengendalian Kusta. Jakarta: Departemen Kesehatan RI. 2012.
13. World Health Organization. Report of informal consultation on treatment of reactions and prevention of disabilities, 11-13 December 2018, Chennai, India. World Health Organization, Regional Office for South-East Asia; 2019.
14. Menteri Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia No. HK.01.07/MENKES/308/2019 tentang Pedoman Nasional Pelayanan Kedokteran Tatalaksana Kusta. Jakarta: Departemen Kesehatan Republik Indonesia; 2019.
15. Widaty S, Soebono H, Nilasari H, Listiawan Y, Siswati AS, Triwahyudi D, al. Panduan Praktik Klinis bagi Dokter Spesialis Kulit dan Kelamin di Indonesia. Jakarta: Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia; 2017.
16. Upputuri B, Pallapati MS, Tarwater P, Srikantam A. Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: A five-year retrospective analysis from a leprosy referral centre in India. PLOS Neglected Tropical Diseases. 2020;14(10):e0008678.
17. Lambert SM, Alembo DT, Nigusse SD, Yamuah LK, Walker SL, Lockwood DNJ. A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia. PLOS Neglected Tropical Diseases. 2016;10(4):e0004502.
18. Kurtzman D, Vleugels RA, Callen J. Chapter 192: Immunosuppressive and Immunomodulatory Drugs. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 3517-30.
19. Jitendra SSV, Bachaspatimayum R, Devi AS, Rita S. Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report. J Clin Diagn Res. 2017;11(8):FD01-FD2.
20. Honaker JS, Korman NJ. Chapter 190: Cytotoxic and Antimetabolic Agents. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 3463-92.
21. Perez-Molina JA, Arce-Garcia O, Chamorro-Tojeiro S, Norman F, Monge-Maillo B, Comeche B, dkk. Use of methotrexate for leprosy reactions. Experience of a referral center and systematic review of the literature. Travel Med Infect Dis. 2020;37:101670.
22. Hasan Z, Mowla MR, Angkur DM, Khan MI. Efficacy and Safety of Prednisolone Monotherapy Versus Prednisolone Plus Methotrexate in Erythema Nodosum Leprosum (Type 2 Lepra Reaction). International Journal of Dermatology and Venereology. 2020;3(4).
23. de Barros B, Lambert SM, Shah M, Pai VV, Darlong J, Rozario BJ, dkk. Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial. BMJ Open. 2020;10(11):e037700.
24. Narang T, Kaushik A, Dogra S. Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases. Br J Dermatol. 2020;182(4):1034-7.
25. Gudjonsson JE, Elder JT. Chapter 28: Psoriasis. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 457-97.
26. Mitra D. A Randomized Controlled Trial of Anti-TNF α Bio-similar Adalimumab vs. Prednisolone in the Management of Leprosy Patients with New Type 1 Lepra Reaction. Open Forum Infect Dis. 2017;4(Suppl 1):S675-S.
27. Johnston A, Takada Y, Hwang ST. Chapter 193: Immunobiologics: Targeted Therapy Againts Cytokines, Cytokine Receptors, and Growth Factors in Dermatology. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 3530-57
28. Mitra D. 811. A Randomized Controlled Trial of Prednisolone vs. Interleukin 17 A Inhibitor Secuinumab in the Management of Type 1 Lepra Reaction in Leprosy Patients. Open Forum Infect Dis. 2018;5(Suppl 1):S290-S.
2. Moloo A. Leprosy: new data show steady decline in new cases. 2019. [Cited 18 February 2021]. Available from: https://www.who.int/neglected_diseases/news/Leprosy-new-data-show-steady-decline-in-new-cases/en/.
3. Pemmaraju VR. Leprosy - Number of new leprosy cases. 2020. [Cited 18 February 2021]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-new-leprosy-cases.
4. Widiatma RR, Prakoeswa CRS. Studi Retrospektif: Reaksi Kusta Tipe 1. Berkala Ilmu Kesehatan Kulit dan Kelamin. 2019;31(2):144-9.
5. RSUP dr. Sitanala Tangerang. Laporan tahunan instalasi rekam medik. 2020.
6. Polycarpou A, Walker SL, Lockwood DN. A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum. Front Immunol. 2017;8:233.
7. World Health Organization. Leprosy hansen disease: management of reactions and prevention of disabilities: technical guidance. 2020.
8. Wisnu IM, Sjamsoe-Daili ES, Menaldi SL. Kusta. Dalam: Menaldi SL, Bramono K, Indriatmi W, penyunting. Ilmu Penyakit Kulit dan Kelamin. Edisi ke-7. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2016. h. 83-102.
9. Cogen AL, Lebas E, De Barros B, Harnisch JP, Faber WR, Lockwood DN, dkk. Biologics in Leprosy: A Systematic Review and Case Report. Am J Trop Med Hyg. 2020;102(5):1131-6.
10. Fischer M. Leprosy - an overview of clinical features, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017;15(8):801-27.
11. Costa PdSS, Fraga LR, Kowalski TW, Daxbacher ELR, Schuler-Faccini L, Vianna FSL. Erythema Nodosum Leprosum: Update and challenges on the treatment of a neglected condition. Acta Tropica. 2018;183:134-41.
12. Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan. Pedoman Nasional Program Pengendalian Kusta. Jakarta: Departemen Kesehatan RI. 2012.
13. World Health Organization. Report of informal consultation on treatment of reactions and prevention of disabilities, 11-13 December 2018, Chennai, India. World Health Organization, Regional Office for South-East Asia; 2019.
14. Menteri Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia No. HK.01.07/MENKES/308/2019 tentang Pedoman Nasional Pelayanan Kedokteran Tatalaksana Kusta. Jakarta: Departemen Kesehatan Republik Indonesia; 2019.
15. Widaty S, Soebono H, Nilasari H, Listiawan Y, Siswati AS, Triwahyudi D, al. Panduan Praktik Klinis bagi Dokter Spesialis Kulit dan Kelamin di Indonesia. Jakarta: Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia; 2017.
16. Upputuri B, Pallapati MS, Tarwater P, Srikantam A. Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: A five-year retrospective analysis from a leprosy referral centre in India. PLOS Neglected Tropical Diseases. 2020;14(10):e0008678.
17. Lambert SM, Alembo DT, Nigusse SD, Yamuah LK, Walker SL, Lockwood DNJ. A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia. PLOS Neglected Tropical Diseases. 2016;10(4):e0004502.
18. Kurtzman D, Vleugels RA, Callen J. Chapter 192: Immunosuppressive and Immunomodulatory Drugs. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 3517-30.
19. Jitendra SSV, Bachaspatimayum R, Devi AS, Rita S. Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report. J Clin Diagn Res. 2017;11(8):FD01-FD2.
20. Honaker JS, Korman NJ. Chapter 190: Cytotoxic and Antimetabolic Agents. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 3463-92.
21. Perez-Molina JA, Arce-Garcia O, Chamorro-Tojeiro S, Norman F, Monge-Maillo B, Comeche B, dkk. Use of methotrexate for leprosy reactions. Experience of a referral center and systematic review of the literature. Travel Med Infect Dis. 2020;37:101670.
22. Hasan Z, Mowla MR, Angkur DM, Khan MI. Efficacy and Safety of Prednisolone Monotherapy Versus Prednisolone Plus Methotrexate in Erythema Nodosum Leprosum (Type 2 Lepra Reaction). International Journal of Dermatology and Venereology. 2020;3(4).
23. de Barros B, Lambert SM, Shah M, Pai VV, Darlong J, Rozario BJ, dkk. Methotrexate and prednisolone study in erythema nodosum leprosum (MaPs in ENL) protocol: a double-blind randomised clinical trial. BMJ Open. 2020;10(11):e037700.
24. Narang T, Kaushik A, Dogra S. Apremilast in chronic recalcitrant erythema nodosum leprosum: a report of two cases. Br J Dermatol. 2020;182(4):1034-7.
25. Gudjonsson JE, Elder JT. Chapter 28: Psoriasis. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 457-97.
26. Mitra D. A Randomized Controlled Trial of Anti-TNF α Bio-similar Adalimumab vs. Prednisolone in the Management of Leprosy Patients with New Type 1 Lepra Reaction. Open Forum Infect Dis. 2017;4(Suppl 1):S675-S.
27. Johnston A, Takada Y, Hwang ST. Chapter 193: Immunobiologics: Targeted Therapy Againts Cytokines, Cytokine Receptors, and Growth Factors in Dermatology. Dalam: Kang S, Amagai M, Bruckner AL, Alexander H. Enk, Margolis DJ, McMichael AJ, dkk., penyunting. Fitzpatrick's Dermatology. Edisi ke-9. New York: McGraw-Hill Education; 2019. h. 3530-57
28. Mitra D. 811. A Randomized Controlled Trial of Prednisolone vs. Interleukin 17 A Inhibitor Secuinumab in the Management of Type 1 Lepra Reaction in Leprosy Patients. Open Forum Infect Dis. 2018;5(Suppl 1):S290-S.
1.png)
