Efficacy of the HLA-B*58:01 Screening Test in Preventing Allopurinol-Induced Severe Cutaneous Adverse Reactions in Patients with Chronic Renal Insufficiency-A Prospective Study
- Title
- Efficacy of the HLA-B*58:01 Screening Test in Preventing Allopurinol-Induced Severe Cutaneous Adverse Reactions in Patients with Chronic Renal Insufficiency-A Prospective Study
- Author
- 박준성
- Keywords
- Allopurinol; HLA-B*58:01 allele; Drug hypersensitivity; Renal insufficiency; Chronic
- Issue Date
- 2019-04
- Publisher
- ELSEVIER SCIENCE BV
- Citation
- JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, v. 7, NO 4, Page. 1271-1276
- Abstract
- BACKGROUND: Thus far, human leukocyte antigen (HLA)-B*58:01 has been recognized as the most important risk factor for allopurinol induced severe cutaneous adverse reactions (SCARs).
OBJECTIVE: To determine the usefulness of prospective screening for the HLA-B*58:01 allele to identify Korean individuals at risk for SCARs induced by allopurinol treatment.
METHODS: We prospectively enrolled 542 patients with chronic renal insufficiency (CRI) from 10 hospitals nationwide and performed DNA genotyping to determine whether they carried the HLA-B*58:01 allele. Of these, 503 HLA-B*58:01-negative patients (92.8% of total) were treated with allopurinol, and 39 HLA-B*58:01-positive patients (7.2%) were treated with febuxostat, an alternative drug. The patients then were followed up biweekly for 90 days using a telephone survey to monitor symptoms of adverse drug reactions, including SCARs. As a control, we used the historical incidence rate of allopurinol-induced SCARs in 4002 patients with CRI from the same hospitals who were enrolled retrospectively.
RESULTS: Nineteen patients in the prospective cohort developed mild and transient adverse reactions but none showed allopurinol-induced SCARs. By contrast, we identified 38 patients with allopurinol-induced SCARs (0.95%) in the historical control. The difference in the incidence of allopurinol-induced SCARs between the prospective cohort and historical control was statistically significant (0% vs 0.95%, respectively; P = .029).
CONCLUSIONS: The present study demonstrated the clinical usefulness of the HLA-B*58:01 screening test before allopurinol administration to prevent allopurinol-induced SCARs in patients with CRI. (C) 2018 American Academy of Allergy, Asthma & Immunology
- URI
- https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2213219818308341?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2213219818308341%3Fshowall%3Dtrue&referrer=https://repository.hanyang.ac.kr/handle/20.500.11754/108053
- ISSN
- 2213-2198; 2213-2201
- DOI
- 10.1016/j.jaip.2018.12.012
- Appears in Collections:
- COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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