HLA-B*15:11 status and carbamazepine-induced severe cutaneous adverse drug reactions in HLA-B*15:02 negative Chinese.

ABSTRACT

BACKGROUND: HLA-B*1511 is associated with carbamazepine (CBZ)-induced severe cutaneous adverse drug reactions (SCARs) in Japanese and some Asian populations, but such data remains relatively limited in Chinese. Routine HLA-B*1502 screening is mandatory before CBZ commencement, however, SCARs related to CBZ were still observed in non-HLA*B-1502 carriers. OBJECTIVE: We aimed to find out the prevalence of HLA-B*1511 in Chinese patients and its associations with CBZ-induced SCARs. METHOD: We screened 8,328 blood samples collected for HLA allele typing before CBZ commencement during the period of January 2014 to December 2019. In HLA-B*1502 negative Chinese patients, HLA-B*1511 status were further screened, and the incidence of SCARs in the CBZ group was compared with the control group without CBZ use. RESULT: In this cohort, 1416 out of 8328 patients (17%) tested HLA-B*1502 positive and were advised to avoid CBZ, while 80 (0.96%) were found to be HLA-B*1511 positive. In 6911 (83%) patients who tested HLA-B*1502 negative, 70 (1.01%) were HLA-B*1511 positive. Five out of 70 (7.14%) patients had SCARs. The incidence of SCARs in HLA-B*1511 carriers who received CBZ was significantly higher than those without CBZ (17.4% [4/23] vs. 2.13% [1/47], P = 0.037*). The odds ratio was 9.68 (95% CI 1.02-92.4, P = 0.048*). These included one Stevens-Johnson syndrome (SJS), two DRESS, and one MPE after CBZ use, while one developed MPE after phenytoin use in control. CONCLUSION: HLA-B*1511 is a potential risk factor of CBZ-induced SCARs in HLA-B*1502 negative Chinese patients. Further screening of HLA-B*1511 status in those HLA-B*1502 negative patients is recommended to avoid undesirable SCARs.