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
- 주제(키워드) Allopurinol , HLA-B*58:01 allele , Drug hypersensitivity , Renal insufficiency , Chronic
- 주제(기타) Allergy
- 주제(기타) Immunology
- 설명문(일반) [Park, Heung-Woo; Kim, Dong Ki; Lee, Jung Pyo] Seoul Natl Univ, Dept Internal Med, Coll Med, 103 Daehak Ro, Seoul 03080, South Korea; [Kim, Sae-Hoon; Kim, Sejoong; Chae, Dong-Wan] Seoul Natl Univ, Dept Internal Med, Bundang Hosp, Seongnam, South Korea; [Yang, Min-Suk; Oh, Yun Kyu; Lee, Jung Pyo] Seoul Natl Univ, Dept Internal Med, Boramae Med Ctr, Seoul, South Korea; [Jung, Jae-Woo; Shin, Jungho; Hwang, Jin Ho] Chung Ang Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Kang, Min-Gyu; Kim, Sun Moon; Kwon, Soon Kil; Kim, Hye-Young] Chungbuk Natl Univ, Dept Internal Med, Coll Med, Cheongju, South Korea; [Kim, Min-Hye; Kim, Seung-Jung; Ryu, Dong-Ryeol; Cho, Young-Joo] Ewha Womans Univ, Coll Med, Dept Internal Med, Seoul, South Korea; [Jee, Young-Koo; Kim, So Mi; Lee, Eun Kyoung] Dankook Univ, Dept Internal Med, Coll Med, Cheonan, South Korea; [Kim, Ju-Young; Cho, Hyun Seop; Jeong, Yi Yeong] Gyeongsang Natl Univ Hosp, Dept Internal Med, Jinju, South Korea; [Kim, Sang-Heon; Jun, Jae-Bum; Park, Joon-Sung; Kim, Gheun-Ho] Hanyang Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Kim, Sujeong; Jung, Hee-Yeon; Lee, Jong-Myung] Kyungpook Natl Univ, Dept Internal Med, Sch Med, Daegu, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 ELSEVIER
- 발행년도 2019
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000171907
- 본문언어 영어
- Published As https://dx.doi.org/10.1016/j.jaip.2018.12.012
- PubMed https://pubmed.ncbi.nlm.nih.gov/30580048
초록/요약
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
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