Clitoria ternatea L. Extract as Adjuvant Therapy on Reducing IL–6 Levels in Reversal Reaction

Nadya Audina N. S(1), Muflihatul Muniroh(2), Novi Kusumaningrum(3), Farmaditya E P M(4), Renni Yuniati(5),

(1) Biomedical Science, Faculty of Medicine, Diponegoro University, Indonesia
(2) Department of Physiology, Faculty of Medicine, Diponegoro University, Indonesia
(3) Dermatology and Venereology Department, Faculty of Medicine, Diponegoro University, Indonesia
(4) Histology Department, Faculty of Medicine, Diponegoro University, Indonesia
(5) Dermatology and Venereology Department, Faculty of Medicine, Diponegoro University, Indonesia


Reversal reaction is a type IV cellular hypersensitivity reaction in leprosy. Interleukin-6 is a mediator with a pleiotropic effect on inflammation and immune response. Steroids are the standard therapy in the treatment of reaction reversal. Clitoria ternatea flower extract has anti-inflammatory properties. Long-term use of steroids can cause side effects. Therefore, it is necessary to give adjuvant therapy that can shorten the treatment period. This study aims to analyze the effect of adjuvant therapy of Clitoria ternatea extract to reduce IL-6 levels in reversal reaction. Experimental research design with pre and post-randomized single-blinded controlled trial, involving 22 subjects with reversal reaction. The control group received standard therapy and the treatment group received standard and adjuvant therapy with Clitoria ternatea extract. IL-6 levels were measured by ELISA. Data analysis used the Wilcoxon test and Independent T-test. The results showed a significant difference in treatment group (p=0.003) and control group (p=0.016). The mean decrease in serum IL-6 levels in treatment group was 81.35 pg/ml and in control group was 24.30 pg/ml (p=0.027). Clitoria ternatea showed a significant IL-6-lowering effect in patients with reversal reactions. This study has demonstrated the potential of Clitoria ternatea extract as adjuvant therapy in patients with leprosy reactions.


Leprosy Reaction, Reversal Reaction; C. ternatea, IL-6; Anti-inflammatory

Full Text:



Al-Snafi, A. E. (2016). Pharmacological importance of Clitoria ternatea-A review. IOSR Journal Of Pharmacy, 6(3), 68–83.

Aljebab, F., Choonara, I., & Conroy, S. (2017). Systematic review of the toxicity of long- course oral corticosteroids in children. PLoS ONE, 12(1), 1–18.

Antonius, A., Arisanti, Y., Tanjung, R., & Mirino, Y. (2018). Faktor Risiko Potensial Reaksi Kusta Pada Etnis Asli di Dua Kantong Kusta – Papua. Buletin Penelitian Kesehatan, 46(4), 225–232.

Ayudianti, P., Suyoso, S., Indramaya, D. M. (2014). Kadar Kortisol Serum Pasien Eritema Nodosum Leprosum (ENL) Baru. Bikkk, 26(2), 90-96.

Cahyaningsih, E., Era, S. K. P., & Santoso, P. (2019). Skrining Fitokimia dan Uji Aktivitas Antioksidan Ekstrak Etanol Bunga Telang (Clitoria Ternatea L.) dengan Metode Spektrofotometri Uv-Vis. Jurnal Ilmiah Medicamento, 5(1), 51–57.

Cortela, D. C. B., Souza Junior, A. L. D., Virmond, M. C. L., & Ignotti, E. (2015). Inflammatory mediators of leprosy reactional episodes and dental infections: A systematic review. Mediators of Inflammation.

Darmaputra, I. G. N., & Ganeswari, P. A. D. (2018). Peran sitokin dalam kerusakan saraf pada penyakit kusta: tinjuan pustaka. Intisari Sains Medis, 9(3), 92–100.

Escher, G. B., Marques, M. B., do Carmo, M. A. V., Azevedo, L., Furtado, M. M., Sant’Ana, A. S., da Silva, M. C., Genovese, M. I., Wen, M., Zhang, L., Oh, W. Y., Shahidi, F., Rosso, N. D., & Granato, D. (2020). Clitoria ternatea L. petal bioactive compounds display antioxidant, antihemolytic and antihypertensive effects, inhibit α-amylase and α-glucosidase activities and reduce human LDL cholesterol and DNA induced oxidation. Food Research International, 128(October 2019), 108763.

Firdaus, F. (2019). Risiko keterlambatan berobat dan reaksi kusta dengan cacat tingkat 2. Jurnal Berkala Epidemiologi, 7(1), 25–32.

Fischer, M. (2017). Leprosy – an overview of clinical features, diagnosis, and treatment. JDDG - Journal of the German Society of Dermatology, 15(8), 801–827.

Froes, L. A. R., Trindade, M. A. B., & Sotto, M. N. (2020). Immunology of leprosy. International Reviews of Immunology, 0(0), 1–21.

Ginwala, R., Bhavsar, R., Chigbu, D. G. I., Jain, P., & Khan, Z. K. (2019). Potential role of flavonoids in treating chronic inflammatory diseases with a special focus on the anti-inflammatory activity of apigenin. Antioxidants, 8(2), 1–28.

Kamal, M., & Martini, S. (2015). Kurangnya konseling dan penenemuan kasus secara pasif mempengaruhi kejadian kecacatan kusta tingkat II di Kabupaten Sampang. Jurnal Berkala Epidemiologi, 3(3).

Khadge, S., Banu, S., Bobosha, K., van der Ploeg-van Schip, J. J., Goulart, I. M., Thapa, P., Kunwar, C. B., van Meijgaarden, K. E., van den Eeden, S. J. F., Wilson, L., Kabir, S., Dey, H., Goulart, L. R., Lobato, J., Carvalho, W., Bekele, Y., Franken, K. L. M. C., Aseffa, A., Spencer, J. S., … Geluk, A. (2015). Longitudinal immune profiles in type 1 leprosy reactions in Bangladesh, Brazil, Ethiopia and Nepal. BMC Infectious Diseases, 15(1), 1–12.

Kimura, A., & Kishimoto, T. (2010). IL-6: Regulator of Treg/Th17 balance. European Journal of Immunology, 40(7), 1830–1835.

Lastória, J. C., & de Abreu, M. A. M. M. (2014). Leprosy: Review of the epidemiological, clinical, and etiopathogenic aspects - Part 1. Anais Brasileiros de Dermatologia, 89(2), 205–218.

Lee, D. J., Rea, T. H., & Modlin, R. L. (2012). Chapter 186. Leprosy. in: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. (editors). Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: Mc Graw Hill, 2253–2262.

Lockwood, D. N. J., Suneetha, L., De Sagili, K., van Chaduvula, M., Mohammed, I., van Brakel, W., Smith, W. C., Nicholls, P., & Suneetha, S. (2011). Cytokine and protein markers of leprosy reactions in skin and nerves: Baseline results for the north indian infir cohort. PLoS Neglected Tropical Diseases, 5(12).

Meiningtyas, D. E., & Hargono, A. (2018). Hubungan faktor demografi dan dukungan sosial dengan kualitas hidup pasien kusta multibasiler pasca multy drug therapy (studi kasus di rs kusta sumberglagah mojokerto). Journal of Public Health, 13(2), 256–267.

Meita Ardini Pratamasari, M. Y. L. (2015). Retrospective Study: Type 1 Leprosy Reaction. Berkala Ilmu Kesehatan Kulit Dan Kelamin - Periodical of Dermatology and Venereology, 27, 137–143.

Mungroo, M. R., Khan, N. A., & Siddiqui, R. (2020). Mycobacterium leprae: Pathogenesis, diagnosis, and treatment options. Microbial Pathogenesis, 149(June), 104475.

Naafs, B., & van Hees, C. L. M. (2016). Leprosy type 1 reaction (formerly reversal reaction). Clinics in Dermatology, 34(1), 37–50.

Nair, V., Bang, W. Y., Schreckinger, E., Andarwulan, N., & Cisneros-Zevallos, L. (2015). Protective Role of Ternatin Anthocyanins and Quercetin Glycosides from Butterfly Pea (Clitoria ternatea Leguminosae) Blue Flower Petals against Lipopolysaccharide (LPS)-Induced Inflammation in Macrophage Cells. Journal of Agricultural and Food Chemistry, 63(28), 6355–6365.

Nazli, P. A. N., Lubis, S. R., & Khairina, K. (2021). Correlation between the stress scale with cortisol levels in leprosy patients. Bali Medical Journal, 10(1), 500.

Negera, E., Tilahun, M., Bobosha, K., Lambert, S. M., Walker, S. L., Spencer, J., Aseffa, A., Dockrell, H. M., & Lockwood, D. N. (2018). The effects of prednisolone treatment on serological responses and lipid profiles in Ethiopian leprosy patients with Erythema Nodosum Leprosum reactions. PLoS Neglected Tropical Diseases, 12(12), 1–16.

Retno, I.W., Djoko, S., Himbawi, M., & Riyanto, P. (2017). The Effect of Black Cumin Supplementation on the Level of Interferon-γ in Multibacillary Leprosy Patient under MDT-WHO Therapy. Clinical Dermatology Open Access Journal, 2(2).

Primasanti, F., Suryaatmadja, L., & Djoko, R. S. (2016). Effect of Nigella Sativa on IL-10 in MB Leprosy that Received MDT-WHO Therapy. Journal of Biomedicine and Translational Research, 2(1), 5.

Ramaswamy, V., Varghese, N., & Simon, A. (2011). an Investigation on Cytotoxic and Antioxidant Properties of Clitoria Ternatea L. International Journal of Drug Discovery, 3(1), 74–77.

Rosdiana, B. I., Astari, L., Astindari, A., Prakoeswa, C. R. S., Zulkarnain, I., Damayanti, D., Utomo, B., & Listiawan, M. Y. (2021). The Profile of Type 1 Leprosy Reaction at Leprosy Division of Dermatology and Venerology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Berkala Ilmu Kesehatan Kulit Dan Kelamin, 33(3).

Sari, L. P. V. C., & Darmada, I. G. K. (2018). Prevalensi dan Karakteristik Penderita Reaksi Kusta Tipe 1 di Poliklinik Kulit dan Kelamin RSUP Sanglah Periode Januari - Desember 2014. E-Jurnal Medika, 7(11), 1–5.

Siswati, A. S., Rini, L. U., & Rinonce, H. T. (2021). Interleukin-6 Sebagai Faktor Risiko Terjadinya Reaksi Lepra Dini. Media Dermato Venereologica Indonesiana, 48(1).

Suganya, G., Sampath Kumar, P., Dheepa, B., & Sivakumar, R. (2014). In vitro antidiabetic, antioxidant and anti-inflammatory activity of Clitoria Ternatea L. International Journal of Pharmacy and Pharmaceutical Sciences, 6(7), 342–347.

Thilavech, T., Adisakwattana, S., Channuwong, P., Radarit, K., Jantarapat, K., Ngewlai, K., Sonprasan, N., & Chusak, C. (2021). Clitoria ternatea flower extract attenuates postprandial lipemia and increases plasma antioxidant status responses to a high-fat meal challenge in overweight and obese participants. Biology, 10(10).

Timu, Y., Tira, D. S., & Nur, M. L. (2021). Analysis of Internal and External Factors Related to Compliance with Drug Drinking in Patients Leprosy in Kupang City. Lontar: Journal of Community Health, 3(2), 54–61.

Vionni, Arifputra, J., & Arifputra, Y. (2016). Reaksi Kusta. Cermin Dunia Kedokteran, 43(7), 501–504.

Williams, D. M. (2018). Clinical pharmacology of corticosteroids. Respiratory Care, 63(6), 655–670.

World Health Organization (WHO). (2020). Global leprosy (Hansen disease) update, 2020: impact of COVID-19 on global leprosy control. Weekly Epidemiological Record, 96(36), 421–444.

Yuniati, R. (2017). Perbedaan Kadar IL-8 Pada Penderita Kusta Tipe MB Dengan Reaksi Reversal. Media Medika Muda,2(l),21–26.

Yuniati, R., & Agusni, I. (2018). IL-6 levels in leprosy patients with reversal reactions. Pakistan Journal of Medical and Health Sciences, 12(3), 1340–1342.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.