The Link between HLA-B Alleles and Causative Drugs in Vietnamese Patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

  • Tran Thi Huyen Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Pham Dinh Hoa Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Trinh Minh Trang Department of Skin diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Nguyen Ba Khanh Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
  • Tran Ngoc Que Department of Stem cells, National Institute of Hematology and Blood Transfusion, Hanoi, Vietnam
  • Nguyen Hoang Phuong Center of Allergy and Clinial Immunology, Bach Mai Hospital, Hanoi, Vietnam
  • Nguyen Minh Hoang Center of Allergy and Clinial Immunology, Bach Mai Hospital, Hanoi, Vietnam
  • Riichiro Abe Department of Dermatology, Niigata University, Japan
  • Nguyen Van Thuong Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Pham Thi Lan Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
  • Michael Tirant Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
Keywords: HLA-B allele, Stevens-Johnson syndrome/toxic epidermal necrolysis, Polymerase chain reaction-sequence-specific oligonucleotide, Carbamazepine, Traditional medicine, Allopurinol

Abstract

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reactions. Human leukocyte antigens (HLA) may play an important role in the pathogenesis of SJS/TEN.

AIMS: This study aims to identify HLA-B alleles in Vietnamese patients with SJS/TEN and to investigate the possible link between HLA-B alleles and causative drugs.

MATERIALS AND METHODS: Sixty patients including SJS (30 patients) and TEN (30 patients) were enrolled in a cross-sectional descriptive study at two hospitals in Hanoi, Vietnam, from July 2018 to July 2019. Clinical features and laboratory findings were noted, HLA-B alleles were analyzed by the polymerase chain reaction (PCR)-sequence-specific oligonucleotide assay and LuminexTM Multiplex Technology.

RESULTS: The most common HLA-B allele was HLA-B*15:02 (41.7%) followed by HLA-B*58:01 (25%) and HLA-B*46:01 (15%). Of the 25 patients possessing HLA-B*15:02 allele, culprit medicines were carbamazepine (13 patients; 52%), traditional medicine (two patients; 8%), and unknown drugs (seven patients; 28%). Of the 15 patients carrying HLA-B*58:01 allele, there were 13 patients whose offending medicine was allopurinol. Of the eight patients whose culprit drug was traditional medicine, there were 6 patients (75%) carrying HLA-B*51:02. Patients who carry HLA-B*15:02 were found to have 4 times higher risk of developing carbamazepine-induced SJS/TEN as compared with the tolerant control group (OR=4.17; 95% CI=2.07–8.37; p < 0.001).

CONCLUSION: HLA-B*15:02 was the most common HLA-B allele in Vietnamese patients with SJS/TEN. In traditional medicine-induced SJS/TEN patients, HLA-B*51:02 allele might play an important role. The link between the HLA-B genotypes and causative drugs may suggest physicians to avoid risk medications for certain patients.

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Published
2020-06-10
How to Cite
1.
Huyen TT, Hoa PD, Trang TM, Khanh NB, Que TN, Phuong NH, Hoang NM, Abe R, Thuong NV, Lan PT, Tirant M. The Link between HLA-B Alleles and Causative Drugs in Vietnamese Patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Open Access Maced J Med Sci [Internet]. 2020Jun.10 [cited 2020Oct.31];8(B):395-00. Available from: https://www.id-press.eu/mjms/article/view/4906

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