Association between HLA-B*1502 and carbamazepine-induced severe cutaneous adverse drug reactions in a Thai population

Wichittra Tassaneeyakul, Somsak Tiamkao, Thawinee Jantararoungtong, Pei Chen, Shu-Yi Lin, Wei-Hsuan Chen, Parinya Konyoung, Usanee Khunarkornsiri, Narong Auvichayapat, Kasemsin Pavakul, Kongkiat Kulkantrakorn, Charoen Choonhakarn, Siranun Phonhiamhan, Namfon Piyatrakul, Thiti Aungaree, Sunsanee Pongpakdee, Praphan Yodnopaglaw
Epilepsia 2010, 51 (5): 926-30
Carbamazepine (CBZ) has been reported as the most common culprit drug for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in several Asian countries including Thailand. A strong association between HLA-B*1502 and CBZ-induced SJS/TEN has been reported in Han Chinese but not in Caucasian and Japanese populations. A case-control study was conducted to determine whether HLA-B*1502 is a valid pharmacogenetic test for SJS/TEN caused by CBZ in a Thai population. Among 42 CBZ-induced patients with SJS/TEN, 37 (88.10%) patients carried the HLA-B*1502 while only 5 (11.90%) of the CBZ-tolerant controls had this allele. The risk of CBZ-induced SJS/TEN was significantly higher in the patients with HLA-B*1502, with an odds ratio (OR) of 54.76 [95% confidence interval (CI) 14.62-205.13, p = 2.89 x 10(-12)]. The sensitivity and specificity of HLA-B*1502 for prediction of CBZ-induced SJS/TEN were 88.10%. By assuming a 0.27% as a prevalence rate of CBZ-induced SJS/TEN in a Thai population, the positive predictive value (PPV) and negative predictive value (NPV) of the HLA-B*1502 were 1.92% and 99.96%. Results from this study suggest that HLA-B*1502 may be a useful pharmacogenetic test for screening Thai individuals who may be at risk for CBZ-induced SJS and TEN.

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