1
|
Tan-Koi WC, Sung C, Chong YY, Lateef A, Pang SM, Vasudevan A, Aw D, Lui NL, Lee SX, Ren EC, Koay ES, Tay YK, Lim YL, Lee HY, Dong D, Loke C, Tan L, Limenta M, Lee EJ, Toh D, Chan CL. Tailoring of recommendations to reduce serious cutaneous adverse drug reactions: a pharmacogenomics approach. Pharmacogenomics 2017; 18:881-890. [PMID: 28594314 DOI: 10.2217/pgs-2017-0016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Health Sciences Authority launched a pharmacogenetics initiative in 2008 to facilitate evaluation of pharmacogenetics associations pertinent for Chinese, Malays and Indians in Singapore. The aim was to reduce the incidence and unpredictability of serious adverse drug reactions, with a focus on serious skin adverse drug reactions. This paper describes the gathering of evidence and weighing of factors that led to different genotyping recommendations for HLA-B*15:02 with carbamazepine and HLA-B*58:01 with allopurinol, despite both having strong genetic associations. Translation of pharmacogenomics at a national level requires careful deliberation of the prevalence of at-risk allele, strength of genetic associations, positive predictive value, cost-effectiveness and availability of alternative therapies. Our experience provides a perspective on translating genomic discoveries in advancing drug safety.
Collapse
Affiliation(s)
- Wei Chuen Tan-Koi
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cynthia Sung
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore.,Health Services & Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Yong Yeow Chong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Internal Medicine Centre, Raffles Hospital, Singapore, Singapore
| | - Aisha Lateef
- Division of Rheumatology, National University Hospital, Singapore, Singapore
| | - Shiu Ming Pang
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Archana Vasudevan
- Department of Rheumatology, Changi General Hospital, Singapore, Singapore
| | - Derrick Aw
- Division of Dermatology, National University Hospital, Singapore, Singapore
| | - Nai Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Shan Xian Lee
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Ee Chee Ren
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Evelyn Sc Koay
- Molecular Diagnosis Centre, National University Hospital, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yong Kwang Tay
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | | | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Di Dong
- Health Services & Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore.,Global Health Research Center, Duke-Kunshan University, Kunshan, China
| | - Celine Loke
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore
| | - Liesbet Tan
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore
| | - Michael Limenta
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore
| | - Edmund Jd Lee
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dorothy Toh
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore
| | - Cheng Leng Chan
- Health Products Regulation Group, Health Sciences Authority, 11 Biopolis Way, 11-03, Helios, Singapore 138667, Singapore
| |
Collapse
|
2
|
Tan CW, Tan-Koi WC, Ng J, Chan CM, Hwang WYK. A cluster of Epoetin-associated pure red cell aplasia: clinical features and the possible association of HLA-DRB1*12:02. Pharmacogenomics 2016; 17:1235-1243. [PMID: 27348021 DOI: 10.2217/pgs-2016-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Antibody-mediated pure red cell aplasia is a rare but serious complication in chronic kidney disease patients receiving recombinant human erythropoietin (r-HuEpo). Between April 2012 and May 2013, eight such cases were reported in our institution. Their clinical features were reviewed and their HLA alleles were compared with those of healthy controls. All patients were exposed to epoetin alfa (Eprex®) with polysorbate-80 as stabilizer via subcutaneous route with a mean age of 61.9 years and mean exposure of 11.2 months of r-HuEpo before loss of efficacy. 87.5% of the cases were male and Chinese and received immunosuppression as treatment for pure red cell aplasia. All three of the successfully treated patients are alive compared with only 40% of the transfusion-dependent patients. DRB1*12:02 was more frequently expressed among the cases than healthy controls suggesting a plausible molecular link.
Collapse
Affiliation(s)
- Chuen Wen Tan
- Department of Haematology, Singapore General Hospital, Singapore
| | - Wei-Chuen Tan-Koi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jennifer Ng
- Department of Paediatrics, Georgetown University, Washington, DC 20007, USA
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | |
Collapse
|