Association of HLA-A*31:01 Screening With the Incidence of Carbamazepine-Induced Cutaneous Adverse Reactions in a Japanese Population
Autor: | Masako Watanabe, Tetsuo Shiohara, Teiichi Onuma, Nobuyuki Izumida, Toshihiko Kinoshita, Tetsumasa Kamei, Katsuya Takeuchi, Masaki Kato, Yoshiro Saito, Michiaki Kubo, Tomohiro Oshima, Shinji Saitoh, Taisei Mushiroda, Mitsutoshi Okazaki, Atsushi Watanabe, Kosuke Kanemoto, Kayoko Saito, Yoshiaki Yamamoto, Takeshi Ozeki, Yukitoshi Takahashi, Hisashi Tanii, Naoki Akamatsu, Takahisa Furuta, Shingo Yasumoto, Naoto Yamada, Yoko Kano, Kotaro Otsuka, Tohru Hoshida, Minoru Hara, Yasushi Shimo, Atsushi Takahashi, Shiro Minami, Toshihiko Fukuchi, Shigenobu Ishida |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male medicine.medical_specialty Drug-Related Side Effects and Adverse Reactions Adolescent MEDLINE Drug Hypersensitivity 03 medical and health sciences Young Adult 0302 clinical medicine Japan Internal medicine Medicine Humans 030212 general & internal medicine Erythema multiforme Young adult Child Original Investigation Aged Aged 80 and over HLA-A Antigens business.industry Incidence (epidemiology) Incidence Infant Newborn Infant Carbamazepine Odds ratio Middle Aged medicine.disease Toxic epidermal necrolysis Pharmacogenomic Testing Neurology Child Preschool Stevens-Johnson Syndrome Drug Hypersensitivity Syndrome Anticonvulsants Female Neurology (clinical) Drug Eruptions business 030217 neurology & neurosurgery medicine.drug Cohort study |
Zdroj: | JAMA neurology. 75(7) |
ISSN: | 2168-6157 |
Popis: | IMPORTANCE: Carbamazepine, a commonly used antiepileptic drug, is one of the most common causes of cutaneous adverse drug reactions (cADRs) worldwide. The allele HLA-A*31:01 is reportedly associated with carbamazepine-induced cADRs in Japanese and European populations; however, the clinical utility of HLA-A*31:01 has not been evaluated. OBJECTIVE: To assess the use of HLA-A*31:01 genetic screening to identify Japanese individuals at risk of carbamazepine-induced cADRs. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted across 36 hospitals in Japan from January 2012 to November 2014 among 1202 patients who had been deemed suitable to start treatment with carbamazepine. Preemptive HLA-A*31:01 genetic screening was performed for 1187 participants. Patients who did not start treatment with carbamazepine or alternative drugs were excluded. Participants were interviewed once weekly for 8 weeks to monitor the development of cADRs. Data analysis was performed from June 8, 2015, to December 27, 2016. EXPOSURES: Neuropsychiatrists were asked to prescribe carbamazepine for patients who tested negative for HLA-A*31:01 and alternative drugs for those who tested positive for HLA-A*31:01. MAIN OUTCOMES AND MEASURES: Incidence of carbamazepine-induced cADRs. RESULTS: Of the 1130 included patients who were prescribed carbamazepine or alternative drugs, the mean (range) age was 37.4 (0-95) years, 614 (54.3%) were men, and 198 (17.5%) were positive for HLA-A*31:01. Expert dermatologists identified 23 patients (2.0%) who had carbamazepine-induced cADRs, of which 4 patients required hospitalization. Drug-induced hypersensitivity syndrome was observed for 3 patients, maculopapular eruption for 9 patients, erythema multiforme for 5 patients, and an undetermined type of cADR for 6 patients. No patient developed Stevens-Johnson syndrome or toxic epidermal necrolysis. Compared with historical controls, the incidence of carbamazepine-induced cADRs was significantly decreased (for BioBank Japan data: incidence, 3.4%; odds ratio, 0.60; 95% CI, 0.36-1.00; P = .048; for the Japan Medical Data Centre claims database: incidence, 5.1%; odds ratio, 0.39; 95% CI, 0.26-0.59; P |
Databáze: | OpenAIRE |
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