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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=http://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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