Utility of human leukocyte antigen-B∗58:01 genotyping and patient outcomes

Ching Hua Ke, Wen Hung Chung, You Lin Tain, Yaw Bin Huang, Yen Hsia Wen, Hung Yi Chuang, Chien Ning Hsu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

12 Scopus citations

Abstract

Aim Human leukocyte antigen (HLA-B∗58:01) allele screening before allopurinol administration is recommended to prevent gene-mediated severe cutaneous adverse reactions (SCARs). The objective of the analysis was to examine the clinical utility and effects of HLA-B∗58:01 genotyping on patient's outcomes in a practice setting. Patients and methods The electronic medical records covering diagnosis, laboratory results, and prescription dispensing for patients who were newly treated with allopurinol or tested for HLA-B∗58:01 were obtained from a large medical organization in Taiwan between 2010 and 2014. The uptake of HLA-B∗58:01 testing, incidence of allopurinol-associated SCAR, and changes in urate-lowering agent utilization were assessed. Results A total of 17 532 allopurinol new users were identified from 2010 to 2014, and the HLA-B∗58:01 test was ordered for 2844 (21.76%) of 13 069 new users when available between 2011 and 2014 in the study. The allopurinol-related SCAR events decreased from 0.21% (22/4460) to 0 (0/2167) after the introduction of HLA-B∗58:01 testing, accompanied by a gradual increase from 8% (326/4207) to 31% (674/2167) in genotype testing rate. However, the HLA-B∗58:01 testing performed before allopurinol prescription was 60.34%, and 40% of patients were tested after already taking allopurinol. A shift from allopurinol to other urate-lowering agent regimens appeared among new allopurinol users. Conclusion HLA-B∗58:01 test was associated with the prevention of allopurinol-induced SCAR. The clinical utility of genotype testing may not be consistent with recommendations for testing, and treatment alternatives are a competitive intervention associated with effective implications in a real-world setting.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalPharmacogenetics and Genomics
Volume29
Issue number1
DOIs
StatePublished - 01 01 2019

Bibliographical note

Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • allopurinol
  • drug safety
  • human leukocyte (HLA-B∗58:01) allele
  • pharmacogenetic test
  • severe cutaneous adverse reactions
  • urate-lowering agent

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