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
- Authors
- Park, H.-W.; Kim, D.K.; Kim, S.; Kim, S.; Chae, D.-W.; Yang, M.-S.; Oh, Y.K.; Lee, J.P.; Jung, J.-W.; Shin, J.; Hwang, J.H.; Kang, M.-G.; Kim, S.; Kwon, S.K.; Kim, H.-Y.; Kim, M.-H.; Kim, S.; Ryu, D.-R.; Cho, Y.-J.; Jee, Y.-K.; Kim, S.; Lee, E.K.; Kim, J.-Y.; Cho, H.S.; Jeong, Y.Y.; Kim, S.; Jun, J.-B.; Park, J.-S.; Kim, G.-H.; Kim, S.; Jung, H.-Y.; Lee, J.-M.
- Issue Date
- Apr-2019
- Publisher
- American Academy of Allergy, Asthma and Immunology
- Keywords
- Allopurinol; Chronic; Drug hypersensitivity; HLA-B ∗ 58:01 allele; Renal insufficiency
- Citation
- Journal of Allergy and Clinical Immunology: In Practice, v.7, no.4, pp 1271 - 1276
- Pages
- 6
- Journal Title
- Journal of Allergy and Clinical Immunology: In Practice
- Volume
- 7
- Number
- 4
- Start Page
- 1271
- End Page
- 1276
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/26414
- DOI
- 10.1016/j.jaip.2018.12.012
- ISSN
- 2213-2198
2213-2201
- 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. © 2018 American Academy of Allergy, Asthma & Immunology
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