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Guo Y, Liu Y, Li D, Wang X, Huang S, Yang L. Clinical observation and analysis of rash caused by lacosamide in children with epilepsy. Seizure 2024; 117:105-110. [PMID: 38367318 DOI: 10.1016/j.seizure.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE To draw clinical attention to rashes caused by lacosamide. METHODS This retrospective analysis included patients admitted to the Department of Pediatrics, Second Affiliated Hospital of Xi'an Jiaotong University between January 2021 and September 2023. We focused on patients who developed rashes after lacosamide treatment and analyzed all patients who exhibited rashes after lacosamide treatment to analyze the risk factors. RESULTS In total, 190 patients received lacosamide, of whom four developed allergies (2.1 %). Three patients had severe rashes, and two patients had high fever. All of these adverse events improved after the withdrawal of lacosamide. Of the 13 patients reported to date, including the four patients in this study, eight used various antiseizure medicines, including seven patients who used four or more antiseizure medicines. Four patients underwent testing for HLA-B*1502, and two patients were positive. Patients developed rashes within 1-10 days after treatment initiation, and the duration of the rash ranged 2-37 days. CONCLUSIONS Lacosamide-induced rash was detected in 2.1 % of patients in our cohort. Rashes are potentially serious, and prompt evaluation is required. Rashes are more likely to occur when multiple antiseizure medicines are used simultaneously, typically within 10 days of treatment initiation.
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Affiliation(s)
- Yingying Guo
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Yu Liu
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Dan Li
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Xueying Wang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Shaoping Huang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Lin Yang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China.
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Zhu X, Luo G, Zheng L. Update on HLA-B*15:02 allele associated with adverse drug reactions. Pharmacogenomics 2024; 25:97-111. [PMID: 38305022 DOI: 10.2217/pgs-2023-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
HLA alleles, part of the major histocompatibility complex, are strongly associated with adverse drug reactions (ADRs). This review focuses on HLA-B*15:02 and explores its association with ADRs in various ethnic populations and with different drugs, aiming to provide insights into the safe clinical use of drugs and minimize the occurrence of ADRs. Furthermore, the review explores the potential mechanisms by which HLA-B*15:02 may be associated with ADRs, aiming to gain new insights into drug modification and identification of haptens. In addition, it analyzes the frequency of the HLA-B*15:02, genotyping methods, cost-effectiveness and treatment measures for adverse reactions, thereby providing a theoretical basis for formulating clinical treatment plans.
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Affiliation(s)
- Xueting Zhu
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guanghua Luo
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Lu Zheng
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Zhu X, Yu Y, Zhang J, Zhan Y, Luo G, Zheng L. Accurate identification of HLA-B*15:02 allele by two-dimensional polymerase chain reaction. Clin Chim Acta 2024; 552:117654. [PMID: 37972805 DOI: 10.1016/j.cca.2023.117654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND HLA-B*15:02 is highly associated with carbamazepine-induced SJS/TEN; however, there is no rapid and accurate detecting method. Here, we present a method to distinguish HLA-B*15:02 from 16 highly homologous HLA-B*15 alleles. METHODS The high-throughput two-dimensional polymerase chain reaction (2D-PCR) technology was employed to identify HLA-B*15:02 in two-tube reaction. And, 2D-PCR accuracy was verified by PCR-sequence based typing (PCR-SBT). RESULTS HLA-B*15:02 heterozygotes were identified by 14 melting valleys in the first tube reaction and none in the second, or by 13 melting valleys in the first tube reaction and one in the second. HLA-B*15:02 homozygote was identified by 13 melting valleys in the first tube reaction and none in the second. Three (0.16%) HLA-B*15:02 homozygotes and 84 (4.59%) HLA-B*15:02 heterozygotes were detected in 1830 samples of clinical general population without detecting 16 highly homologous alleles to HLA-B*15:02. The kappa test showed 100% coincidence between the 2D-PCR and PCR-SBT. CONCLUSIONS 2D-PCR in two-tube reaction method for identifying HLA-B*15:02 was successfully established. Identification of HLA-B*15:02 is necessary prior to taking CBZ based on HLA-B*15:02 allele frequency.
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Affiliation(s)
- Xueting Zhu
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yang Yu
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jun Zhang
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yuxia Zhan
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guanghua Luo
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Lu Zheng
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Meng Q, Gu H, Zhang Q, Yi Z, Jiang D. Carbamazepine cutaneous adverse reactions and HLA gene variation in the Chinese population: a systematic review and meta-analysis. Pharmacogenomics 2023; 24:459-474. [PMID: 37503628 DOI: 10.2217/pgs-2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Aim: Examining the association between HLA-A/B alleles and different carbamazepine (CBZ)-induced cutaneous adverse reactions in the Chinese population. Methods: A systematic review and meta-analysis of case-control studies was conducted. A systematic search was conducted of PubMed, Embase, the Cochrane Library, National Knowledge Infrastructure, the Chinese Biomedical Literature database and Wanfang Digital Periodicals. Results: 23 studies with a total of 1174 patients were included. In the Han population, HLA-B*15:02 is significantly associated with the increased risk of CBZ-related Stevens-Johnson syndrome/toxic epidermal necrolysis, and this correlation was not related to geographic distribution. HLA-A*31:01, B*38:02 are associated with CBZ-related maculopapular eruption in South Han population. HLA-A*31:01 is associated with CBZ-DRESS in Taiwan Han population. Conclusion: HLA-B*15:02, A*31:01 and B*38:02 genes were found to be involved in the occurrence of CBZ cutaneous adverse reactions in Han Chinese.
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Affiliation(s)
- Qingli Meng
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Hongyan Gu
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Qinghua Zhang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Zhanmiao Yi
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, China
- Institute for drug evaluation, Peking University Health Science Center, Beijing, 100191, China
| | - Dechun Jiang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
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Biswas M, Ershadian M, Shobana J, Nguyen A, Sukasem C. Associations of
HLA
genetic variants with carbamazepine‐induced cutaneous adverse drug reactions: An updated meta‐analysis. Clin Transl Sci 2022; 15:1887-1905. [PMID: 35599240 PMCID: PMC9372413 DOI: 10.1111/cts.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
Aggregated risk of carbamazepine (CBZ)‐induced cutaneous adverse drug reactions (cADRs) with different HLA variants are unclear and limited in terms of the power of studies. This study aimed to assess the aggregated risk of CBZ‐induced cADRs associated with carrying the following HLA variants: HLA‐B*15:02, HLA‐B*15:11, HLA‐B*15:21, HLA‐B*38:02, HLA‐B*40:01, HLA‐B*46:01, HLA‐B*58:01, HLA‐A*24:02, and HLA‐A*31:01. Literature was searched in different databases following PRISMA guidelines. The outcomes were measured as odds ratio (OR) using RevMan software by a random/fixed effects model, where p < 0.05 was set as statistical significance. In total, 46 case–control studies met the inclusion criteria and were included in this analysis consisting of 1817 cases and 6614 controls. It was found that case‐patients who carried the HLA‐B*15:02 allele were associated with a significantly increased risk of CBZ‐induced Stevens−Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) compared to controls (OR 26.01; 95% CI 15.88–42.60; p < 0.00001). The aggregated risk of cADRs was slightly higher in Asian compared to Caucasian patients (Asians: OR 14.84; 95% CI 8.95–24.61; p < 0.00001; Caucasians: OR 11.65; 95% CI 1.68–80.70; p = 0.01). Further, HLA‐B*15:11, HLA‐B*15:21, or HLA‐A*31:01 allele was also associated with significantly increased risk of CBZ‐induced cADRs (HLA‐B*15:11: OR 6.08; 95% CI 2.28–16.23; p = 0.0003; HLA‐B*15:21: OR 5.37; 95% CI 2.02–14.28; p = 0.0008; HLA‐A*31:01: OR 5.92; 95% CI 4.35–8.05; p < 0.00001). Other HLA variants were not found to have any significant associations with CBZ‐induced cADRs. Strong associations between the HLA‐B*15:02, HLA‐B*15:11, HLA‐B*15:21, or HLA‐A*31:01 allele with CBZ‐induced cADRs have been established in this analysis. Pharmacogenetic testing of particular HLA alleles before initiation of CBZ therapy may be beneficial to patients and may help to eradicate cADRs substantially.
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Affiliation(s)
- Mohitosh Biswas
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital Bangkok Thailand
- Department of Pharmacy University of Rajshahi Rajshahi Bangladesh
| | - Maliheh Ershadian
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital Bangkok Thailand
| | - John Shobana
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital Bangkok Thailand
| | - Ai‐Hoc Nguyen
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital Bangkok Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital Bangkok Thailand
- Pharmacogenomics and Precision Medicine, The Preventive Genomics & Family Check‐up Services Center Bumrungrad International Hospital Bangkok Thailand
- Department of Pharmacology and Therapeutics, MRC Centre for Drug Safety Science, Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
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