The risk of anti-osteoporotic agent-induced severe cutaneous adverse drug reactions and their association with HLA.
J Eur Acad Dermatol Venereol
; 35(3): 712-720, 2021 Mar.
Article
em En
| MEDLINE
| ID: mdl-32896010
ABSTRACT
BACKGROUND:
There is increasing use of anti-osteoporotic agents (AOA) worldwide for prevention or management of patients with osteoporosis. However, there have been reports of severe cutaneous adverse reactions (SCAR) induced by AOA. A recent study showed weak association between HLA and strontium ranelate (SR)-SCAR.OBJECTIVE:
To characterize patients with AOA-SCAR and investigate the HLA association and utility of in vitro diagnostic methods.METHODS:
We enrolled 16 cases with AOA-cutaneous adverse drug reactions (cADR), including SCAR (n = 10 8 with Stevens-Johnson syndrome [SJS] and 2 with drug rash with eosinophilia and systemic symptoms [DRESS]) and maculopapular exanthema (MPE) (n = 6) from Taiwan and Hong Kong. We analysed the clinical characteristics, outcomes, HLA alleles and in vitro testing of AOA-SCAR, and tolerability to alternative drugs. We further performed literature review and meta-analysis on the HLA association of AOA-SCAR.RESULTS:
Our data showed strontium ranelate is the most common causality of AOA-SCAR in Asian populations. There was no cross-hypersensitivity of SR-SCAR with other AOA. HLA genotyping showed that SR-SJS was most significantly associated with HLA-A*3303 (Pc = 5.17 × 10-3 , OR 25.97, 95% CI 3.08-219.33). Meta-analysis showed that HLA-A*3303 was associated with SR-SJS (P = 5.01 × 10-5 ; sensitivity 85.7%) in Asians. The sensitivity of lymphocyte activation test (LAT) for identifying the culprit drug of SR-SJS was 83.3%.CONCLUSIONS:
Strontium ranelate is identified as the most notorious AOA associated with SCAR. The HLA-A*3303 genetic allele and LAT testing may add benefits to the diagnosis of SR-SCAR in patients whose reaction developed while taking multiple drugs.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síndrome de Stevens-Johnson
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
País/Região como assunto:
Asia
Idioma:
En
Revista:
J Eur Acad Dermatol Venereol
Assunto da revista:
DERMATOLOGIA
/
DOENCAS SEXUALMENTE TRANSMISSIVEIS
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Taiwan