Human Leukocyte Antigen Class I Genes Associated With Stevens-Johnson Syndrome and Severe Ocular Complications Following Use of Cold Medicine in a Brazilian Population.

ABSTRACT

Importance Describing the association with human leukocyte antigen (HLA) alleles could facilitate the understanding of increased risk factors for development of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in patients with severe ocular complications (SOCs). Objective: To investigate the association between HLA class I genes and cold medicine (CM)-associated SJS/TEN with SOCs. Design, Setting, and Participants: This case-control study was conducted between February 8, 2013, and August 29, 2014. Thirty-nine Brazilian patients with CM-SJS/TEN of 74 patients with SJS/TEN with SOCs and 133 healthy Brazilian volunteers were enrolled. Human leukocyte antigen class I genes (HLA-A, HLA-B, and HLA-C) were examined to determine whether there was a genetic predisposition for CM-SJS/TEN with SOC. Patients were interviewed to identify possible etiologic factors. Data analysis was performed from April 14, 2013, to August 29, 2014. Main Outcomes and Measures: Genetic predisposition for CM-SJS/TEN with SOCs by analysis of HLA class I genes. Results: Of 74 patients included in the analysis, 32 (43%) were male; mean (SD) age was 36.01 [15.42] years. HLA-A*6601 (odds ratio [OR], 24.0; 95% CI, 2.79-206.0; P < .001), HLA-B*4403 (OR, 2.71; 95% CI, 1.11-6.65; P = .04), and HLA-C*1203 (OR, 5.6; 95% CI, 1.67-18.80; P = .006) were associated with Brazilian CM-SJS/TEN with SOCs, and HLA-A*1101 (OR, 0.074; 95% CI, 0.004-1.26; P = .008), HLA-B*0801 (OR, 0.15; 95% CI, 0.02-1.15; P = .048), and HLA-B*5101 (OR, 0.23; 95% CI, 0.05-1.03; P = .045) were inversely associated with Brazilian CM-SJS/TEN with SOCs (39 cases 19 Pardo and 16 European ancestry; 14 males and 25 females; age, 35.2 [14.4] years; and 133 controls 66 Pardo and 61 European ancestry; 55 males and 78 females; age, 41.2 [12.9] years). When multiple test correction within the HLA locus, HLA-A*6601 and HLA-C*1203 demonstrated associations. When participants were segregated into Pardo and locus is considered, HLA-A*6601 was associated with CM-SJS/TEN with SOC among individuals of both ethnic groups (Pardo OR, 12.2; 95% CI, 1.19-125.0; P = .03; and European OR, 21.2; 95% CI, 0.97-465.0; P = .04). An association was observed only in the European cohort for HLA-B*4403 (OR, 5.50; 95% CI, 1.47-20.50; P = .01) and HLA-C*1203 (OR, 8.79; 95% CI, 1.83-42.20; P = .008). Conclusions and Relevance This study suggests that HLA-A*6601 might be a marker for CM-SJS/TEN with SOCs in Brazilian individuals of Pardo and European ancestry and that HLA-B*4403 and HLA-C*1203 might be markers only in those of European ancestry. Moreover, HLA-A*1101 might be a marker of resistance to CM-SJS/TEN with SOCs.