HLA-B*1502 Increases the Risk of Phenytoin or Lamotrigine Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Evidence from a Meta-analysis of Nine Case-control Studies

Li, X.; Yu, Kefu; Mei, Shenghui; Huo, Jian-Wei; Wang, J.; Zhu, Yueyong; Zhao, Zhigang

doi:10.1055/s-0034-1375684

Cited by 26 publications

(32 citation statements)

References 13 publications

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“…HLA B*15:02 is associated with SJS and TEN due to CBZ intake in Han Chinese population, but not with MPE 6. Evidence from another meta-analysis of nine case-control studies by Li X et al shows significant association between HLA-A*15:02 and PHT and LTG-induced SJS/TEN 19. A pilot-study showed that the same allele may be associated with OXC-induced mild cutaneous reactions 20.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients

et al. 2016

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Background and PurposeAromatic antiepileptic drugs are frequently implicated for cutaneous adverse drug reactions (cADRs); there are case-reports of even severe reactions like drug reaction eosinophilia and systemic symptoms (DRESS) and Stevens Johnson syndrome (SJS)-toxic epidermal necrolysis with Levetiracetam (LEV). Certain human leukocyte antigen (HLA)-alleles have strong association with cADRs due to specific drugs - HLA-B*15:02 and HLA-A*31:01 in Carbamazepine (CBZ)-related SJS in Han-Chinese and European populations, respectively. Here, the spectrum of cADRs to LEV was studied, and HLA-typing in patients with cADRs due to LEV and some who were LEV-tolerant was performed, in an attempt to find an association between HLA and such reactions.Methods589 patients taking LEV were screened for skin reactions, and eight patients with LEV-related cADRs and 25 LEV-tolerant controls were recruited - all 33 of North Indian ethnicity, their HLA-A, B, DRB1 genotyping done. Statistical analysis was done to compare carrier-rates and allele-frequencies of HLA-alleles between cases and controls (and healthy population, where necessary) for alleles occurring more than two times in either group.ResultsOut of 589 patients on LEV screened, there were 8 cases of cADR: 5 with maculopapular exanthema (MPE), 2 of SJS, and 1 with DRESS. Although HLA-A*33:01 was seen to occur more in MPE cases as compared to tolerant controls, the difference was not statistically significant (odds ratio [OR] 6.00, 95% confidence interval [CI] 0.30–116.6; p = 0.31). HLA A*11:01 and 24:02 were found to occur more in LEV-tolerant controls than in cases (OR 0.23 [95% CI 0.02–2.36, p = 0.33] and 1.00 [95% CI 0.09–11.02, p = 1.00] respectively).ConclusionsCutaneous reactions to LEV are very unusual, and their association with HLA in North-Indian population was not statistically significant.

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Section: Discussionmentioning

confidence: 99%

Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients

et al. 2016

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“…However, this finding could be replicated only in Han Chinese subjects receiving carbamazepine; in Japanese and Korean subjects receiving carbamazepine, different HLA-B families are found to be related to SJS 15,16. At the present time, most published reports are focused on the relationship between HLA-B families and antiepileptic drugs only 17,18. Although some reports suggest that genetic screening techniques should be devised to screen for the risk of SJS before prescribing such drugs for patients with either epilepsy19,20 or mood disorder,21 another report has tried to investigate the implication of this pharmacogenetics technique in terms of other drugs, but this seems not implacable to be promoted to other drugs at the present time 22…”

Section: Resultsmentioning

confidence: 92%

The severe complication of Stevens–Johnson syndrome induced by long-term clozapine treatment in a male schizophrenia patient: a case report

Wu¹,

Chung²,

Wu³

et al. 2015

NDT

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Introduction:Stevens–Johnson syndrome (SJS) is a severe adverse drug reaction that can result in disability and mortality. SJS is defined as having a widespread distribution throughout the whole body surface area with <10% extent of skin detachment and skin lesions. Some drugs, such as carbamazepine, have been reported to have a greater correlation to SJS. Although clozapine use has been mentioned as a risk factor for development of SJS, no report has clearly described the features of SJS as a reaction to clozapine use. Herein, we report the case of a patient presenting SJS after long-term clozapine treatment.Case report:Mr A was a 54-year-old male with a diagnosis of chronic schizophrenia. He was hospitalized in a mental institute and received clozapine 200 mg/day for 2 years, without discomfort or drug side effects. He developed acute-onset mouth edema, multiple oral and ocular ulcers, oral and ocular mucosa swelling, and multiple erythematous skin rashes over his entire body and extremities with hypertension and high fever. SJS was diagnosed after referral to a general hospital.ResultsThe SJS subsided under supportive treatment.ConclusionAccumulated lymphocytes and macrophages in the epidermis and elevated TNF-α might cause an immune reaction and apoptosis and result in the clinical presentation of SJS. Clozapine is believed to modulate the immunologic reaction, and therefore might induce SJS through immunomodulation. This case highlights the importance of considering the possibility of SJS resulting from the use of drugs for which there are no reports of such a severe complication.

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“…Certain medications such as phenytoin, carbamazepine, and lamotrigine may cause Stevens-Johnson syndrome or toxic epidermal necrolysis. 50,51 Although rare, if one of those disorders is ignored and the medication continues to be administered, either Stevens-Johnson syndrome or toxic epidermal necrolysis can evolve into a life-threatening situation.…”

Section: Dermatologicmentioning

confidence: 99%

Status Epilepticus in Adults: A Review of Diagnosis and Treatment

Lawson

Yeager

2016

Critical Care Nurse

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Status epilepticus is a medical emergency that requires rapid diagnosis and treatment. Nonconvulsive status epilepticus is frequently underdiagnosed and therefore undertreated, which can lead to permanent neuronal damage resulting in disability or death. Despite the frequent occurrence and morbidity associated with status epilepticus, this topic has received little attention within the literature. A systematic approach to treatment should start with management of airway, breathing, and circulation, followed by administration of benzodiazepines and intravenous antiepileptic drugs, and rapid escalation of therapy to prevent morbidity and mortality. Armed with the information in this article, nurses will have a higher-level understanding of what to do when encountering a patient in status epilepticus. (Critical Care Nurse. 2016; 36[2]:62-73)

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HLA-B*1502 Increases the Risk of Phenytoin or Lamotrigine Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Evidence from a Meta-analysis of Nine Case-control Studies

Abstract: There is a significant association between HLA-B*1502 and PHT or LTG-induced SJS/TEN.

Cited by 26 publications

References 13 publications

Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients

Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients

The severe complication of Stevens–Johnson syndrome induced by long-term clozapine treatment in a male schizophrenia patient: a case report

Status Epilepticus in Adults: A Review of Diagnosis and Treatment

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HLA-B*1502 Increases the Risk of Phenytoin or Lamotrigine Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Evidence from a Meta-analysis of Nine Case-control Studies

Abstract: There is a significant association between HLA-B*1502 and PHT or LTG-induced SJS/TEN.

Cited by 26 publications

References 13 publications

Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients

Spectrum of Cutaneous Adverse Reactions to Levetiracetam and Human Leukocyte Antigen Typing in North-Indian Patients

The severe complication of Stevens&ndash;Johnson syndrome induced by long-term clozapine treatment in a male schizophrenia patient: a&nbsp;case&nbsp;report

Status Epilepticus in Adults: A Review of Diagnosis and Treatment

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The severe complication of Stevens–Johnson syndrome induced by long-term clozapine treatment in a male schizophrenia patient: a case report