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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
Authors
Park, Heung-WooKim, Dong KiKim, Sae-HoonKim, SejoongChae, Dong-WanYang, Min-SukOh, Yun KyuLee, Jung PyoJung, Jae-WooShin, JunghoHwang, Jin HoKang, Min-GyuKim, Sun MoonKwon, Soon KilKim, Hye-YoungKim, Min-HyeKim, Seung-JungRyu, Dong-RyeolCho, Young-JooJee, Young-KooKim, So MiLee, Eun KyoungKim, Ju-YoungCho, Hyun SeopJeong, Yi YeongKim, Sang-HeonJun, Jae-BumPark, Joon-SungKim, Gheun-HoKim, SujeongJung, Hee-YeonLee, Jong-Myung
Ewha Authors
조영주김승정류동열김민혜
SCOPUS Author ID
조영주scopus; 김승정scopus; 류동열scopus; 김민혜scopus
Issue Date
2019
Journal Title
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
ISSN
2213-2198JCR Link

2213-2201JCR Link
Citation
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE vol. 7, no. 4, pp. 1271 - 1276
Keywords
AllopurinolHLA-B*58:01 alleleDrug hypersensitivityRenal insufficiencyChronic
Publisher
ELSEVIER SCIENCE BV
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
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
DOI
10.1016/j.jaip.2018.12.012
Appears in Collections:
의과대학 > 의학과 > Journal papers
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