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Duong KN, Nguyen DV, Chaiyakunapruk N, Nelson RE, Malone DC. Cost-effectiveness of HLA-B*58:01 testing to prevent Stevens-Johnson syndrome/toxic epidermal necrolysis in Vietnam. Pharmacogenomics 2023; 24:713-724. [PMID: 37706247 DOI: 10.2217/pgs-2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Background: HLA-B*58:01 is strongly associated with allopurinol-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in Vietnam. This study assessed the cost-effectiveness of this testing to prevent SJS/TEN. Methods: A model was developed to compare three strategies: no screening, use allopurinol; HLA-B*58:01 screening; and no screening, use probenecid. A willingness-to-pay of three-times gross domestic product per capita was used. Results: Compared with 'no screening, use allopurinol', 'screening' increased quality-adjusted life-years by 0.0069 with the incremental cost of Vietnam dong (VND) 14,283,633 (US$617), yielding an incremental cost-effectiveness ratio of VND 2,070,459,122 (US$89,398) per quality-adjusted life-year. Therefore, 'screening' was unlikely to be cost-effective under the current willingness-to-pay. Testing's cost-effectiveness may change with targeted high-risk patients, reimbursed febuxostat or lower probenecid prices. Conclusion: The implementation of nationwide HLAB*58:01 testing before the use of allopurinol is not cost-effective, according to this analysis. This may be due to the lack of quality data on the effectiveness of testing and costing data in the Vietnamese population.
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Affiliation(s)
- Khanh Nc Duong
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Dinh Van Nguyen
- Department of Internal Medicine, Respiratory, Allergy & Clinical Immunology Unit, Vinmec Healthcare System, Hanoi, Vietnam
- College of Health Sciences, Vin University, Hanoi, Vietnam
- Department of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
| | - Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Liu Y, Wang CW, Chen CB, Yu KH, Wu YJ, Choon SE, Chang WC, Yang F, Luo XQ, Chung WH, Zhao M, Lu QJ. DNA methylation of ITGB2 contributes to allopurinol hypersensitivity. Clin Immunol 2023; 248:109250. [PMID: 36738816 DOI: 10.1016/j.clim.2023.109250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS HLA-B*58:01 allele was strongly associated with allopurinol induced severe cutaneous adverse drug reaction (SCAR). However, HLA-B genotype is not sufficient to predict the occurrence of allopurinol-induced SCAR. OBJECTIVE To discover DNA methylation markers for allopurinol-induced SCAR which may improve the prediction accuracy of genetic testing. STUDY DESIGN The study was designed as a retrospective case-control clinical study in multicenter hospitals across Taiwan, Mainland China, Malaysia and Canada. 125 cases of allopurinol-induced SCAR patients and 139 cases of allopurinol tolerant controls were enrolled in this study during 2005 to 2021. RESULTS The results of genome-wide DNA methylation assay of 62 patients revealed that ITGB2 showed strong discriminative ability of allopurinol-induced SCAR in both HLA-B*58:01 positive and negative patients with AUC value of 0.9364 (95% CI 0.8682-1.000). In validation study, significant hypermethylation of ITGB2 were further validated in allopurinol-induced SCAR patients compared to tolerant controls, especially in those without HLA-B*58:01(AUC value of 0.8814 (95% CI 0.7121-1.000)). Additionally, the methylation levels of 2 sites on ITGB2 were associated with SCAR phenotypes. Combination of HLA-B*58:01 genotyping and ITGB2 methylation status could improve the prediction accuracy of allopurinol-induced SCAR with the AUC value up to 0.9387 (95% CI 0.9089-0.9684), while the AUC value of HLA-B*58:01 genotyping alone was 0.8557 (95% CI 0.8030-0.9083). CONCLUSIONS Our study uncovers differentially methylated genes between allopurinol-induced SCAR patients and tolerant controls with positive or negative HLA-B*58:01 allele and provides the novel epigenetic marker that improves the prediction accuracy of genetic testing for prevention of allopurinol-induced SCAR.
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Affiliation(s)
- Yu Liu
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, China; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, China; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan China; College of Medicine, Chang Gung University, Taoyuan, Taiwan China
| | - Kuang-Hui Yu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan China; Division of Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan China
| | - Yeong-Jian Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan China; Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chang Gung Memorial Hospital, Keelung and Linkou, Taiwan China
| | - Siew-Eng Choon
- Hospital Sultanah Aminah, Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - Wan-Chun Chang
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Fanping Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Qun Luo
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, China; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan China; College of Medicine, Chang Gung University, Taoyuan, Taiwan China; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan China; Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China.
| | - Ming Zhao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China; Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Qian-Jin Lu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China; Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China.
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Wong CSM, Yeung CK, Chan CY, Yap DYH, Tang SCW, Cheung BMY, Kwok JSY, Chan HHL. HLA-B*58:01 screening to prevent allopurinol-induced severe cutaneous adverse reactions in Chinese patients with chronic kidney disease. Arch Dermatol Res 2021; 314:651-659. [PMID: 34213582 DOI: 10.1007/s00403-021-02258-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022]
Abstract
Human leukocyte antigen (HLA)-B*58:01 allele is a significant risk factor for allopurinol-induced severe cutaneous adverse reactions (SCARs) which is potentially fatal. In some studies, chronic kidney disease (CKD) was also implicated to compound the risk of SCARs. We aim to investigate if pre-treatment HLA-B*58:01 screening can prevent allopurinol-induced SCARs in Chinese patients with CKD and its cost-effectiveness. We prospectively recruited Chinese CKD patients who required allopurinol during 2011-2015 and performed pre-treatment HLA testing (HLA screening group). Patients tested positive for HLA-B*58:01 were refrained from allopurinol while those tested negative were prescribed allopurinol. The incidence of SCARs in the HLA screening group was compared with the historical control in previous 5 years and the cost-effectiveness of HLA testing was analyzed. In the historical control (2006-2010), 3605 patients on allopurinol were screened, 22 out of 1027 (2.14%) CKD Chinese patients newly started on allopurinol developed SCARs, including 6 SJS/TEN. In the HLA screening group, 28 out of 192 patients (14.6%) tested HLA-B*58:01 positive were advised to avoid allopurinol; 156 out of 164 HLA-B*58:01-negative patients received allopurinol and none developed SCARs. The incidence rate of SCARs was significantly lower in the HLA screening group compared with controls (0% vs 2.14% respectively, p = 0.037*). The targeted HLA screening approach was associated with lower healthcare costs compared with no HLA screening (US$ 92,430 vs US$ 281,226). Pre-treatment HLA-B*58:01 screening is cost-effective to target on patients with CKD in Chinese to prevent allopurinol-induced SCARs.
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Affiliation(s)
- Christina Sze-Man Wong
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chi-Keung Yeung
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chun-Yin Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Desmond Yat-Hin Yap
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sydney Chi-Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bernard Man-Yung Cheung
- Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Janette Siu-Yin Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Henry Hin-Lee Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. .,Dermatology and Laser Centre, 1 Wellington Street, Central, Hong Kong SAR, China.
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Do MD, Mai TP, Do AD, Nguyen QD, Le NH, Le LGH, Hoang VA, Le AN, Le HQ, Richette P, Resche-Rigon M, Bardin T. Risk factors for cutaneous reactions to allopurinol in Kinh Vietnamese: results from a case-control study. Arthritis Res Ther 2020; 22:182. [PMID: 32746911 PMCID: PMC7397637 DOI: 10.1186/s13075-020-02273-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate risk factors for cutaneous adverse reactions (CARs) in Kinh Vietnamese. METHODS All patients were prospectively recruited in Ho Chi Minh City. Presence of the HLA-B*58:01 allele was determined by real-time PCR-sequence-specific amplification by using the PG5801 Detection Kit (Pharmigene, Taipei). Patients with severe (SCARs) and mild (MCARs) CARs and controls were compared for differences in features prospectively collected, and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS On comparing 32 patients with SCARs and 395 tolerant controls, we identified eight strong risk factors: increased age (OR 15.1 [95% CI 5.8-40.1], P < 0.0001), female sex (OR 333 [40-43,453], P < 0.0001), allopurinol for asymptomatic hyperuricemia (OR 955 [120-125,847], P < 0.0001), allopurinol starting dose > 150 mg (OR 316 [101-122], P < 0.0001), diuretics intake (OR 304 [35-40,018], P < 0.0001), eGFR < 60 ml/min/1.73 m2 (OR 100 [32-353], P < 0.0001), history of allopurinol-induced skin reaction (OR 78 [6-10,808], P = 0.004), and HLA-B*58:01 carriage (OR 147 [45-746], P < 0.0001). HLA-B*58:01 allele frequency in controls was 7.3%. For MCARs (n = 74), risk factors were eGFR < 60 ml/min/1.73 m2 (OR 4.9 [1.61-14.6], P = 0.006), history of allopurinol-induced skin reaction (OR 27 [2-3777], P = 0.01), and asymptomatic hyperuricemia (OR 27 [2-3777], P = 0.01). CONCLUSION This study confirmed 8 risk factors, including HLA-B*58:01, for SCARs and identified 3 risk factors for MCARs in Kinh Vietnamese. HLA-B*58:01 genotyping could guide the indication for allopurinol in Kinh Vietnamese patients with gout.
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Affiliation(s)
- Minh Duc Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy, at Ho Chi Minh City, Vietnam
| | - Thao Phuong Mai
- Department of Physiology, Pathophysiology and Immunology, Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Anh Duy Do
- Department of Physiology, Pathophysiology and Immunology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Quang Dinh Nguyen
- French Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Centre, Ho Chi Minh City, Vietnam
| | - Nghia Hieu Le
- French Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Centre, Ho Chi Minh City, Vietnam
| | - Linh Gia Hoang Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy, at Ho Chi Minh City, Vietnam
| | - Vu Anh Hoang
- Center for Molecular Biomedicine, University of Medicine and Pharmacy, at Ho Chi Minh City, Vietnam
| | - Anh Ngoc Le
- Department of Scientific Research, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Hung Quoc Le
- Department of Tropical Disease, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Pascal Richette
- Université de Paris, U1132, INSERM, 75010, Paris, France.,Department of Rheumatology, AP-HP, Lariboisière hospital, 2 rue A. Paré, 75010, Paris, France
| | - Matthieu Resche-Rigon
- Université de Paris, ECSTRRA Team U1153, INSERM, 75010, Paris, France.,Department of Biostatistics, AP-HP, Saint-Louis hospital, 75010, Paris, France
| | - Thomas Bardin
- French Vietnamese Research Center on Gout and Chronic Diseases, Vien Gut Medical Centre, Ho Chi Minh City, Vietnam. .,Université de Paris, U1132, INSERM, 75010, Paris, France. .,Department of Rheumatology, AP-HP, Lariboisière hospital, 2 rue A. Paré, 75010, Paris, France.
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Dou Y, Peng P, Cai C, Ye A, Kong L, Zhang R. HLA-B*58:01 and rs9263726 have a linkage, but not absolute linkage disequilibrium in Han Chinese population. Drug Metab Pharmacokinet 2018; 33:228-231. [PMID: 30193812 DOI: 10.1016/j.dmpk.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022]
Abstract
HLA-B*58:01 has been demonstrated to be associated with allopurinol-induced severe cutaneous adverse reactions. Since HLA-B*58:01 is too complicated to be identified, it is necessary to select an appropriate surrogate biomarker. In Japan, the rs9263726 allele was considered as a surrogate biomarker for HLA-B*58:01, but this was not the case with the Australian cohort. Due to the conflict results, in this study, we aim to demonstrate whether the rs9263726 allele is a surrogate biomarker for HLA-B*58:01 in Han Chinese population. A total of 353 samples (200 cases from the south and 153 cases from the north) were selected to detect HLA-B*58:01 and rs9263726 allele. The HLA-B*58:01 was identified by sequencing-based method, and the rs9263726 allele was identified by Taqman SNP Genotyping Assays. The results showed that the two alleles had a linkage, but not absolute linkage disequilibrium in Han Chinese population.
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Affiliation(s)
- Yaling Dou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Pan Peng
- Wuhan YZY Medical Science and Technology Co Ltd., Wuhan, China
| | - Congli Cai
- Wuhan YZY Medical Science and Technology Co Ltd., Wuhan, China
| | - Ali Ye
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lingjun Kong
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Rui Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Huh JY, Han OJ, Park G. Rapid, Reliable, and Inexpensive HLA-B*58:01 Detection Method Using DNA Binding Dye-based Duplex Allele-specific Melting Curve Analysis. Ann Clin Lab Sci 2018; 48:296-300. [PMID: 29970431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Allopurinol is the most commonly used drug for the treatment of gout and also one of the most common causes of severe cutaneous adverse reactions (SCARs). Human leukocyte antigen-B*58:01 (HLA-B*58:01) is strongly associated with allopurinol-induced SCARs. The aim of the present study was to develop and validate a rapid and economic screening method for HLA-B*58:01. METHODS The accuracy of duplex allele-specific melting curve analysis using DNA-binding dye for HLA-B*58:01 was evaluated in 150 blood samples with sequence-based typing (SBT) as the reference method. RESULTS Fifty HLA-B*58:01-positive and 100 negative results obtained by duplex allele-specific melting curve analysis were completely in agreement with the SBT results. CONCLUSION Duplex allele-specific melting curve analysis is a rapid, reliable and inexpensive assay that is appropriate for screening for the HLA-B*58:01 allele.
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Affiliation(s)
- Ji Young Huh
- Department of Laboratory Medicine, CHA Bundang Medical Center, Gyeonggi-do, CHA University, Korea
| | - Ok Jin Han
- Department of Laboratory Medicine, CHA Bundang Medical Center, Gyeonggi-do, CHA University, Korea
| | - Geon Park
- Department of Laboratory Medicine, Chosun University College of Medicine, Gwangju, Korea
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Wu R, Cheng YJ, Zhu LL, Yu L, Zhao XK, Jia M, Wen CH, Long XZ, Tang T, He AJ, Zeng YY, Ma ZF, Zheng Z, Ni MZ, Cai GJ. Impact of HLA-B*58:01 allele and allopurinol-induced cutaneous adverse drug reactions: evidence from 21 pharmacogenetic studies. Oncotarget 2016; 7:81870-9. [PMID: 27835909 DOI: 10.18632/oncotarget.13250] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022] Open
Abstract
Allopurinol is widely used for hyperuricemia and gouty arthritis, but is associated with cutaneous adverse drug reactions (CADRs). Recently, HLA-B*58:01 allele was identified as a strong genetic marker for allopurinol-induced CADRs in Han Chinese. However, the magnitude of association and diagnosis value of HLA-B*58:01 in allopurinol-induced CADRs remain inconclusive. To investigate this inconsistency, we conducted a meta-analysis of 21 pharmacogenetic studies, including 551 patients with allopurinol-induced CADRs, and 2,370 allopurinol-tolerant controls as well as 9,592 healthy volunteers. The summary OR for allopurinol-induced CADRs among HLA-B*58:01 carriers was 82.77 (95% CI: 41.63 – 164.58, P < 10−5) and 100.87 (95% CI: 63.91 – 159.21, P < 10−5) in matched and population based studies, respectively. Significant results were also observed when stratified by outcomes and ethnicity. Furthermore, the summary estimates for quantitative analysis of HLA-B*58:01 allele carriers in allopurinol-induced CADRs screening were as follows: sensitivity, 0.93 (95% CI: 0.85 – 0.97); specificity, 0.89 (95% CI: 0.87 – 0.91); positive likelihood ratio, 8.24 (95% CI: 6.92 – 9.81); negative likelihood ratio, 0.084 (95% CI: 0.039 – 0.179); and diagnostic odds ratio, 98.59 (95% CI: 43.31 – 224.41). The AUSROC was 0.92 (95% CI: 0.89–0.94), indicating the high diagnostic performance. Our results indicated that allopurinol–SCAR is strongly associated with HLA-B*58:01, and HLA-B*58:01 is a highly specific and effective genetic marker for the detection allopurinol-induced CADRs, especially for Asian descents.
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Plumpton CO, Alfirevic A, Pirmohamed M, Hughes DA. Cost effectiveness analysis of HLA-B*58:01 genotyping prior to initiation of allopurinol for gout. Rheumatology (Oxford) 2017; 56:1729-1739. [PMID: 28957559 DOI: 10.1093/rheumatology/kex253] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Indexed: 01/03/2023] Open
Abstract
Objective To determine whether prospective testing for HLA-B*58:01, as a strategy to prevent serious adverse reactions to allopurinol in patients with gout, is cost-effective from the perspective of the National Health Service in the UK. Methods A systematic review and meta-analysis for the association of HLA-B*58:01 with cutaneous and hypersensitivity adverse drug reactions informed a decision analytic and Markov model to estimate lifetime costs and outcomes associated with testing vs standard care (with febuxostat prescribed for patients who test positive). Scenario analyses assessed alternative treatment assumptions and patient populations. Results The number of patients needed to test to prevent one case of adverse drug reaction was 11 286 (95% central range (CR): 2573, 53 594). Cost and quality-adjusted life-year (QALY) gains were small, £103 (95% CR: £98, £106) and 0.0023 (95% CR: -0.0006, 0.0055), respectively, resulting in an incremental cost-effectiveness ratio (ICER) of £44 954 per QALY gained. The probability of testing being cost-effective at a threshold of £30 000 per QALY was 0.25. Reduced costs of testing or febuxostat resulted in an ICER below £30 000 per QALY gained. The ICER for patients with chronic renal insufficiency was £38 478 per QALY gained. Conclusion Routine testing for HLA-B*58:01 in order to reduce the incidence of adverse drug reactions in patients being prescribed allopurinol for gout is unlikely to be cost-effective in the UK; however testing is expected to become cost-effective with reductions in the cost of genotyping, and with the future availability of cheaper, generic febuxostat.
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Affiliation(s)
- Catrin O Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Wales
| | - Ana Alfirevic
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Wales.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Kim EY, Seol JE, Choi JH, Kim NY, Shin JG. Allopurinol-induced severe cutaneous adverse reactions: A report of three cases with the HLA-B*58:01 allele who underwent lymphocyte activation test. Transl Clin Pharmacol 2017; 25:63-66. [PMID: 32133321 PMCID: PMC7042004 DOI: 10.12793/tcp.2017.25.2.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 12/18/2022] Open
Abstract
Allopurinol-induced severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome are reportedly associated with the HLA-B*58:01 genotype. Three patients who developed SCARs after allopurinol administration were subjected to HLA-B genotyping and lymphocyte activation test (LAT) to evaluate genetic risk and to detect the causative agent, respectively. All three patients given allopurinol to treat gout were diagnosed with DRESS syndrome. Symptom onset commenced 7-24 days after drug exposure; the patients took allopurinol (100-200 mg/d) for 2-30 days. HLA-B genotyping was performed using a polymerase chain reaction (PCR)-sequence-based typing (SBT) method. All patients had a single HLA-B*58:01 allele: HLA-B*13:02/*58:01 (a 63-year-old male), HLA-B*48:01/*58:01 (a 71-year-old female), and HLA-B*44:03/*58:01 (a 22-year-old male). Only the last patient yielded a positive LAT result, confirming that allopurinol was the causative agent. These findings suggest that patients with HLA-B*58:01 may develop SCARs upon allopurinol administration. Therefore, HLA-B genotyping could be helpful in preventing serious problems attributable to allopurinol treatment, although PCR-SBT HLA-B genotyping is time consuming. A simple genotyping test is required in practice. LAT may help to identify a causative agent.
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Affiliation(s)
- Eun-Young Kim
- Department of Clinical Pharmacology, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea
| | - Jung Eun Seol
- Department of Dermatology, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea
| | - Jae-Hyeog Choi
- Department of Microbiology and Immunology, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Na-Yul Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Jae-Gook Shin
- Department of Clinical Pharmacology, Inje University College of Medicine, Busan Paik Hospital, Busan 47392, Republic of Korea.,Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Republic of Korea
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Ke CH, Chung WH, Wen YH, Huang YB, Chuang HY, Tain YL, Wang YCL, Wu CC, Hsu CN. Cost-effectiveness Analysis for Genotyping before Allopurinol Treatment to Prevent Severe Cutaneous Adverse Drug Reactions. J Rheumatol 2017; 44:835-843. [PMID: 28365572 DOI: 10.3899/jrheum.151476] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with an HLA-B*58:01 allele have an increased risk of developing severe cutaneous adverse drug reactions (SCAR) when treated with allopurinol. Although one-off pharmacogenetic testing may prevent life-threatening adverse drug reactions, testing prior to allopurinol initiation incurs additional costs. The study objective was to evaluate the cost-effectiveness of HLA-B*58:01 screening compared with using other available urate-lowering agents (ULA). METHODS A decision-analytical model was used to compare direct medical costs and effectiveness [including lifetime saved, quality-adjusted life-yrs (QALY) gained] in treating new patients with the following options: (1) genetic screening followed by allopurinol prescribing for noncarriers of HLA-B*58:01, (2) prescribing benzbromarone without screening, (3) prescribing febuxostat without screening, and (4) prescribing allopurinol without screening. A 1-year time frame and third-party payer perspective were modeled for both the entire cohort (base-case) and for the subgroup of patients with chronic kidney disease (CKD). RESULTS The incremental cost-effectiveness ratio of genetic screening prior to ULA therapy was estimated as New Taiwan (NT) $234,610 (US$7508) per QALY gained in the base-case cohort. For patients with CKD, it was estimated as NT$230,925 (US$7390) per QALY. The study results were sensitive to the probability of benzbromarone/febuxostat-related hypersensitivity, and a negative predicted value of genotyping. CONCLUSION HLA-B*58:01 screening gave good value for money in preventing allopurinol-induced SCAR in patients indicated for ULA therapy. In addition to the costs of genotyping, it is important to monitor ULA safety closely in adopting HLA-B*58:01 screening in practice.
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Affiliation(s)
- Ching-Hua Ke
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Wen-Hung Chung
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Yen-Hsia Wen
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Yaw-Bin Huang
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Hung-Yi Chuang
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - You-Lin Tain
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Yu-Ching Lily Wang
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Cheng-Chih Wu
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital
| | - Chien-Ning Hsu
- From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
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Sukasem C, Jantararoungtong T, Kuntawong P, Puangpetch A, Koomdee N, Satapornpong P, Supapsophon P, Klaewsongkram J, Rerkpattanapipat T. HLA-B (*) 58:01 for Allopurinol-Induced Cutaneous Adverse Drug Reactions: Implication for Clinical Interpretation in Thailand. Front Pharmacol 2016; 7:186. [PMID: 27486401 PMCID: PMC4947582 DOI: 10.3389/fphar.2016.00186] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 06/13/2016] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this study was to investigate the predisposition to different types of allopurinol-induced cutaneous adverse drug reactions (CADR), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN; SJS-TEN, n = 13), drug reaction with eosinophilia and systemic symptoms (DRESS, n = 10) and Maculopapular eruption (MPE; n = 7), conferred by HLA-B*58:01 in a Thai population. Methods: This case-control association study compares 30 patients with allopurinol-induced CADR, allopurinol-tolerant control patients (n = 100), and a Thai general population (n = 1095). Patients' human leukocyte antigen type B (HLA-B) alleles were genotyped by using a two-stage sequence-specific oligonucleotide probe system. Results: Of a total 30 patients with CADR due to allopurinol, 29 (96.7%) patients were found to be at least heterozygous for HLA-B*58:01, compared to only 4.0% in allopurinol-tolerant patients (p < 0.001). Odds ratio (OR) for the association of HLA-B*58:01 with allopurinol-induced CADR in this population was 696.0 (95% CI: 74.8–6475.0). The HLA-B*58:01 allele was present in all patients with allopurinol-induced SJS-TEN (OR = 579.0, 95%CI: 29.5–11362.7, p < 0.001) and DRESS (OR 430.3, 95%CI: 22.6–8958.9, p < 0.001). Additionally, OR of HLA-B*58:01 was highly significant in the allopurinol-induced MPE patients (OR 144.0, 95%CI: 13.9–1497.0, p < 0.001). Conclusion: In this study we confirmed the association between HLAB*58:01 and allopurinol-induced SJS-TEN in a Thai population. In addition, we identified an association between HLA-B*58:01 and allopurinol-induced DRESS and MPE in this population. Therefore, HLA-B*58:01 can be used as a pharmacogenetic marker for allopurinol-induced CADR including SJS-TEN, DRESS and MPE. These results suggest that screening for HLA-B*58:01 alleles in patients who will be treated with allopurinol would be clinically helpful in preventing the risk of developing CARD in a Thai patients. SummaryRegardless of phenotype, this is the first pharmacogenetic study of allopurinol-induced CADR in patients of Thai ancestry. In this study we confirmed the association between HLA-B*58:01 and allopurinol-induced SJS-TEN, DRESS, and MPE in Thai population. Regarding to our findings, the pharmacogenetic interpretation could be generalized to drug hypersensitivity including DRESS, SJS-TEN, and MPE.
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Affiliation(s)
- Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityBangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center, Ramathibodi HospitalBangkok, Thailand; The Thai Severe Cutaneous Adverse Drug Reaction Research GroupBangkok, Thailand
| | - Thawinee Jantararoungtong
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityBangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center, Ramathibodi HospitalBangkok, Thailand
| | - Parnrat Kuntawong
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok, Thailand
| | - Apichaya Puangpetch
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityBangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center, Ramathibodi HospitalBangkok, Thailand
| | - Napatrupron Koomdee
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityBangkok, Thailand; Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center, Ramathibodi HospitalBangkok, Thailand
| | - Patompong Satapornpong
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok, Thailand
| | - Patcharin Supapsophon
- Department of Pharmacy, Somdech Phra Debaratana Medical Center, Ramathibodi Hospital Bangkok, Thailand
| | - Jettanong Klaewsongkram
- The Thai Severe Cutaneous Adverse Drug Reaction Research GroupBangkok, Thailand; Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunology Research Group, Chulalongkorn UniversityBangkok, Thailand
| | - Ticha Rerkpattanapipat
- The Thai Severe Cutaneous Adverse Drug Reaction Research GroupBangkok, Thailand; Division of Allergy Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityBangkok, Thailand
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Nguyen DV, Vidal C, Li J, Fulton RB, Fernando SL. Validation of a rapid test for HLA-B*58:01/57:01 allele screening to detect individuals at risk for drug-induced hypersensitivity. Pharmacogenomics 2016; 17:473-80. [PMID: 27027663 DOI: 10.2217/pgs.15.185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM In prevention of allopurinol and abacavir hypersensitivity, screening HLA-B*58:01/57:01 has been highly recommended prior to commencing these therapies. Therefore, we aimed at developing and validating a rapid and robust screening method for HLA-B*58:01/57:01. MATERIALS & METHODS Real-time polymerase chain reaction with TaqMan probes was employed to detect HLA-B*58:01/57:01. RESULTS The newly developed assay has the sensitivity of 100% (95% CI: 79.4-100.0%), the specificity of 98.8% (95% CI: 93.6-99.9%), the positive predictive value of 94.1% (95% CI: 71.3-99.9%) and the negative predictive value of 100.0% (95% CI: 95.7-100.0%). The lowest limit of detection is 0.04 ng/µl of DNA. CONCLUSION The present method is a rapid and robust assay that is appropriate for screening of HLA-B*58:01/*57:01 alleles.
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Affiliation(s)
- Dinh Van Nguyen
- ImmunoRheumatology Laboratory, Pathology North - Northern Sydney, St Leonards, Australia.,Sydney Medical School - Northern, University of Sydney, Sydney, Australia.,Department of Allergy & Clinical Immunology, Hanoi Medical University, Hanoi, Vietnam
| | - Christopher Vidal
- ImmunoRheumatology Laboratory, Pathology North - Northern Sydney, St Leonards, Australia
| | - Jamma Li
- ImmunoRheumatology Laboratory, Pathology North - Northern Sydney, St Leonards, Australia
| | - Richard B Fulton
- ImmunoRheumatology Laboratory, Pathology North - Northern Sydney, St Leonards, Australia
| | - Suran L Fernando
- ImmunoRheumatology Laboratory, Pathology North - Northern Sydney, St Leonards, Australia.,Sydney Medical School - Northern, University of Sydney, Sydney, Australia
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Thipmanee O, Numnuam A, Limbut W, Buranachai C, Kanatharana P, Vilaivan T, Hirankarn N, Thavarungkul P. Enhancing capacitive DNA biosensor performance by target overhang with application on screening test of HLA-B*58:01 and HLA-B*57:01 genes. Biosens Bioelectron 2016; 82:99-104. [PMID: 27054813 DOI: 10.1016/j.bios.2016.03.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/12/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
A highly sensitive label-free DNA biosensor based on PNA probes immobilized on a gold electrode was used to detect a hybridization event. The effect of a target DNA overhang on the hybridization efficiency was shown to enhance the detected signal and allowed detection at a very low concentration. The sensors performances were investigated with a complementary target that had the same length as the probe, and the signal was compared to the target DNAs with different lengths and overhangs. A longer target DNA overhang was found to provide a better response. When the overhang was on the electrode side the signal enhancement was greater than when the overhang was on the solution side due to the increased thickness of the sensing surface, hence produced a larger capacitance change. Using conformationally constrained acpcPNA probes, double stranded DNA was detected sensitively and specifically without any denaturing step. When two acpcPNA probes were applied for the screening test for the double stranded HLA-B*58:01 and HLA-B*57:01 genes that are highly similar, the method differentiated the two genes in all samples. Both purified and unpurified PCR products gave comparable results. This method would be potentially useful as a rapid screening test without the need for purification and denaturation of the PCR products.
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Affiliation(s)
- Orawan Thipmanee
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Apon Numnuam
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Warakorn Limbut
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Department of Applied Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Chittanon Buranachai
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Department of Physics, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Proespichaya Kanatharana
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Tirayut Vilaivan
- Organic Synthesis Research Unit, Department of Chemistry, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nattiya Hirankarn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; Center of Excellence in Immunology and Immune-Mediated Diseases, Chulalongkorn University, Bangkok 10330, Thailand.
| | - Panote Thavarungkul
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Department of Physics, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
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Park HJ, Kim YJ, Kim DH, Kim J, Park KH, Park JW, Lee JH. HLA Allele Frequencies in 5802 Koreans: Varied Allele Types Associated with SJS/TEN According to Culprit Drugs. Yonsei Med J 2016; 57:118-26. [PMID: 26632391 PMCID: PMC4696942 DOI: 10.3349/ymj.2016.57.1.118] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are very serious forms of drug-induced cutaneous adverse reaction. SJS/TEN induced by certain drug is well known to be associated with some human leukocyte antigen (HLA) gene type. We aimed to explore HLA allele frequencies and their association with SJS/TEN according to culprit drugs in Korea. MATERIALS AND METHODS We enrolled 5802 subjects who had results of HLA typing test from August 2005 to July 2014. Total 28 SJS/TEN patients were categorized based on culprit drugs (allopurinol, lamotrigine, carbamazepine) and identified the presence of HLA-B*58:01, HLA-B*44:03, HLA-B*15:02, and HLA-A*31:01. RESULTS HLA-A*24:02 (20.5%), HLA-B*44:03 (10.0%), and HLA-Cw*01:02 (17.1%) were the most frequent type in HLA-A, -B, and -C genes, respectively. Allele frequencies of HLA-B*58:01, HLA-B*44:03, HLA-A*31:01, and HLA-B*15:02 were 7.0%, 10.0%, 5.0%, and 0.3%, respectively. In 958 allopurinol users, 9 subjects (0.9%) were diagnosed with SJS/TEN. Among them, 8 subjects possessed HLA-B*58:01 allele. SJS/TEN induced by allopurinol was more frequently developed in subjects with HLA-B*58:01 than in subjects without it [odds ratio: 57.4; confidence interval (CI) 7.12-463.50; p<0.001]. Allopurinol treatment, based on screening by HLA-B*58:01 genotyping, could be more cost-effective than that not based on screening. HLA-B*44:03 may be associated with lamotrigine-induced SJS/TEN (odds ratio: 12.75; CI 1.03-157.14; p=0.053). Among carbamazepine users, only two patients experienced SJS/TEN and possessed neither HLA-B*15:02 nor HLA-A*31:03. CONCLUSION HLA gene frequencies varied in Korea. Screening of HLA-B*58:01 before the use of allopurinol might be needed to anticipate probability of SJS/TEN.
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Affiliation(s)
- Hye Jung Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Young Joo Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Junho Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
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Kang X, Chen R, Han M, Liu Z, Liu J, Dai P, Chen C, Wang H. Rapid and reliable genotyping of HLA-B*58:01 in four Chinese populations using a single-tube duplex real-time PCR assay. Pharmacogenomics 2015; 17:47-57. [PMID: 26652271 DOI: 10.2217/pgs.15.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM HLA-B*58:01 is strongly associated with allopurinol-induced severe cutaneous adverse reactions. This study aimed to develop a new and convenient method for HLA-B*58:01 genotyping and to investigate HLA-B*58:01 distribution in different Chinese populations. MATERIALS & METHODS Combining of sequence-specific primers and TaqMan probe, a single-tube duplex real-time PCR assay for HLA-B*58:01 typing was established. RESULTS The HLA-B*58:01 genotyping result in Buyei (n = 100) by real-time PCR showed 100% concordance with those by sequence-based typing. The prevalence of HLA-B*58:01 carrier in Buyei (17%, n = 100) was significantly higher than those in Northern Han (4%, n = 100), Tibetan (5.1%, n = 99) and Uighur (2%, n = 50) populations (p < 0.05). CONCLUSION The newly developed reliable assay was appropriate for HLA-B*58:01 detection prior to allopurinol administration in clinical settings.
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Affiliation(s)
- Xing Kang
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Rong Chen
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Min Han
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Zhengbin Liu
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Jinhui Liu
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Penggao Dai
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Chao Chen
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
| | - Huijuan Wang
- The National Engineering Research Center for Miniaturized Detection Systems; College of Life Science, Northwest University, Xi'an, China
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