Background The potentially fatal adverse drug reactions Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) are ten times higher in Thai, Han Chinese and Hong Kong Chinese (T/HC/HKC) than the Caucasian population. This is associated with the presence of the human leukocyte antigen HLA-B*1502 which is present in 6.1%/9%/7.2% of the T/HC/HKC populations respectively. It is already established that carbamazepine (CBZ)-induced SJS/TEN is greater in patients with HLA-B*1502. The Medicines and Healthcare products Regulatory Agency and the Food and Drug Administration advise testing for HLA-B*1502 prior to initiation of CBZ in T/HC/HKC patients. They recommend that phenytoin (PHT) should be avoided if the patient is known to have HLA-B*1502 but do not advise routine testing for the allele. However, there is increasing evidence regarding the link between HLA-B*1502 and PHT-induced SJS/TEN that may alter the management of patients of T/HC/HKC origin.
Purpose To assess the association of HLA-B*1502 and PHT-induced SJS/TEN in patients of T/HC/HKC origin.
Material and methods A literature search was performed on PubMed and ScienceDirect databases until October 2014, using search words “phenytoin”, “HLA-B*1502”, “SJS” and “TEN”. Other articles used were those cited in papers identified via the literature search, and analysis was restricted to systematic reviews and meta-analyses to establish the odds ratio (OR).
Results In total, 45 cases and 217 controls were assessed. There was an increased risk of PHT-induced SJS/TEN in patients with the HLA-B*1502 allele compared to those who did not possess the allele. This was statistically significant with OR = 5.87, 95% confidence intervals, 2.87 to 12.04, p value < 0.0001.
Conclusion There is strong evidence associating PHT-induced SJS/TEN and individuals with HLA-B*1502 of T/HC/HKC origin. The occurrence of SJS/TEN could be prevented by routine testing for the HLA-B*1502 allele in patients of T/HC/HKC origin and avoiding use of phenytoin treatment in this subset of patients.
References and/or acknowledgements No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.