Association Between HLA genotypes and Oxcarbazepine-induced Cutaneous Adverse Drug Reactions: A Systematic Review and Meta-Analysis

Wimonchat Tangamornsuksan1, Norman Scholfield1, Manupat Lohitnavy2

1Center of Excellence for Environmental Health & Toxicology, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
2Center of Excellence for Environmental Health & Toxicology, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Pharmacokinetic Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.

Abstract


PURPOSE: To systematically review and quantitatively synthesize associations between HLA genotypes and oxcarbazepine-induced cutaneous adverse drug reactions (OXC-cADRs), including Stevens–Johnson syndrome (SJS) and maculopapular rash. METHODS: Studies investigating associations between HLA genotypes and OXC-cADRs were systematically searched irrespective of language, in PubMed, HuGENet (Human Genome Epidemiology Network), and the Cochrane Library from their inception until January, 2017. Inclusion criteria were studies investigating associations between HLA genotypes and OXC-cADRs that reported sufficient data for calculating the frequency of HLA genotype carriers among cases and controls. Overall odds ratios (ORs) with corresponding 95%CIs were calculated using a random-effects model to determine the association between HLA genotypes and OXC-cADRs.  RESULTS: The initial searches identified 91 articles, of which 6 studies met the selection criteria. The studies included 229 patients with OXC-cADRs, 251 OXC-tolerant patients, and 2,358 participants from general populations of Han Chinese, Korean, and Thai ethnicities.  Associations between HLA-B*1502 and OXC-induced SJS were found in both the general population [OR=30.2 (95%CI=3.45-264)] and in OXC-tolerant individuals [OR=26.4 (95%CI=7.98-87.6)]. An association between the HLA-B*1502 and OXC-induced maculopapular rash was found in the general population [OR=5.67 (95%CI=2.03-15.9)] while HLA-A*3101 also associated with OXC-induced maculopapular rash [overall OR=29.2 (95%CI=6.70-128)].  CONCLUSIONS: Strong associations between the HLA-B*1502 and OXC-cADRs (SJS and maculopapular rash) were found in both controls from general population and OXC-tolerant groups. There was also an association between HLA-B*3101 and OXC-induced maculopapular rash. For patient safety, genetic screening especially for HLA-B*1502 prior to OXC therapy at least in these closely related ethnicities is warranted. Further studies need to better define other ethnicities at risk and a wider range of MHC gene subtypes.

 

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J Pharm Pharm Sci, 21 (1): 1-18, 2018

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DOI: http://dx.doi.org/10.18433/J36S7D