Institute of Biomedical Sciences, Academia Sinica, 128, Academia Road, Section 2, Nankang, Taipei 11529, Taiwan.
Pharmacogenomics. 2010 Mar;11(3):349-56. doi: 10.2217/pgs.09.162.
AIMS: Compared with other categories of drugs, such as antibiotics and NSAIDs, antiepileptic therapies are associated with a high incidence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We previously reported that carbamazepine (CBZ)-SJS/TEN is strongly associated with the HLA-B1502 in Han Chinese, which has been confirmed in other Southeast Asian countries where the allele is prevalent. Here, we extend the study of HLA susceptibility to three different antiepileptic drugs, phenytoin (PHT), lamotrigine (LTG) and oxcarbazepine (OXC), which have structure similarity to CBZ. MATERIALS & METHODS: We carried out a case-control association study. We enrolled 26 PHT-, six LTG- and three OXC-induced SJS/TEN patients, 113 PHT-tolerant and 67 LTG-tolerant subjects who were on the drug, respectively, for more than 3 months without the adverse reactions, and 93 normal subjects from the general population. The HLA-A, B, C and DRB1 genotypes were determined. RESULTS: We found that HLA-B1502 was present in eight out of 26 (30.8%) PHT-SJS/TEN (OR: 5.1; 95% CI: 1.8-15.1; p = 0.0041), two out of six (33%) LTG-SJS (odds ratio [OR]: 5.1; 95% CI: 0.8-33.8; p = 0.1266) and three out of three (100%) OXC-SJS (OR: 80.7; 95% CI: 3.8-1714.4; p = 8.4 x 10(-4)) patients. In addition, HLA-B1301, Cw0801 and DRB11602 also showed an association with PHT-SJS/TEN (p = 0.0128-0.0281; OR: 3.0-4.3). CONCLUSION: Our results indicate that OXC, PHT and LTG, which possess an aromatic ring just as CBZ does, when causing SJS/TEN, share a common risk allele. Aromatic antiepileptic drugs causing SJS/TEN in HLA-B1502 carriers may act on a similar pathogenetic mechanism, although other genetic/nongenetic factor(s) may also contribute to the pathomechanism of the disease. We suggest that aromatic antiepileptic drugs, including CBZ, OXC and PHT, should be avoided in the B*1502 carrier and caution should also be exercised for LTG.
目的:与抗生素和非甾体抗炎药等其他类别药物相比,抗癫痫治疗与史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死松解症(TEN)的发生率较高。我们之前报道过,卡马西平(CBZ)-SJS/TEN 与汉族人群中的 HLA-B*1502 密切相关,这在该等位基因流行的其他东南亚国家已得到证实。在这里,我们将 HLA 易感性研究扩展到三种不同的抗癫痫药物,即苯妥英(PHT)、拉莫三嗪(LTG)和奥卡西平(OXC),它们与 CBZ 具有结构相似性。
材料和方法:我们进行了病例对照关联研究。我们纳入了 26 例 PHT-SJS/TEN 患者、6 例 LTG-SJS 患者和 3 例 OXC-SJS 患者,以及分别接受 PHT 治疗超过 3 个月且无不良反应的 113 例 PHT 耐受患者和 67 例 LTG 耐受患者,以及来自普通人群的 93 名正常对照。确定了 HLA-A、B、C 和 DRB1 基因型。
结果:我们发现,在 26 例 PHT-SJS/TEN 患者中,HLA-B1502 存在于 8 例(30.8%)(比值比 [OR]:5.1;95%CI:1.8-15.1;p = 0.0041),在 6 例 LTG-SJS 患者中存在于 2 例(33%)(OR:5.1;95%CI:0.8-33.8;p = 0.1266),在 3 例 OXC-SJS 患者中存在于 3 例(100%)(OR:80.7;95%CI:3.8-1714.4;p = 8.4 x 10(-4))。此外,HLA-B1301、Cw0801 和 DRB11602 也与 PHT-SJS/TEN 相关(p = 0.0128-0.0281;OR:3.0-4.3)。
结论:我们的结果表明,具有芳香环的 OXC、PHT 和 LTG 在引起 SJS/TEN 时具有共同的风险等位基因,与 CBZ 一样。在 HLA-B1502 携带者中引起 SJS/TEN 的芳香族抗癫痫药物可能作用于相似的致病机制,尽管其他遗传/非遗传因素也可能导致疾病的发病机制。我们建议避免在 B1502 携带者中使用芳香族抗癫痫药物,包括 CBZ、OXC 和 PHT,并对 LTG 保持谨慎。
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