Investigating the association of Lamotrigine and Phenytoin‐induced Stevens‐Johnson syndrome/Toxic Epidermal Necrolysis with HLA‐B*1502 in Iranian population. Issue 2 (4th December 2020)

• Record Type: Journal Article
• Authors: Sabourirad, Sara; Mortezaee, Reza; Mojarad, Majid; Eslahi, Atieh; Shahrokhi, Yahya; Kiafar, Bita; Jarahi, Lida; Afkhami Ardakani, Saman; Farrokhi, Shima
• Is Part Of: Experimental dermatology. Volume 30:Issue 2(2021)
• Page Start: 284
• Page End: 287
• Publication Date: 2020-12-04
• Subjects: HLA‐B Antigens -- lamotrigine -- pharmacogenetics -- phenytoin -- Stevens‐Johnson Syndrome; Dermatology -- Periodicals; 616.5
• DOI: 10.1111/exd.14240
• Languages: English
• ISSNs: 0906-6705

Abstract

Abstract: Previous studies have found an association between HLA‐B*1502 allele and lamotrigine‐induced Stevens‐Johnson syndrome (SJS)/ toxic epidermal necrosis (TEN) spectrum in Han Chinese populations. This study aims to investigate the association between HLA‐B*1502 and lamotrigine‐ or phenytoin‐ induced SJS/TEN in an Iranian population. The medical records of twenty‐eight lamotrigine‐induced SJS/TEN patients and twenty‐five lamotrigine‐tolerant controls as well as eight phenytoin‐induced SJS/TEN and twelve phenytoin‐tolerant controls were extracted between March 2013 and March 2019 from the university hospitals in Mashhad, Iran. The presence of HLA‐B*1502 allele was determined using real‐time polymerase chain reaction (PCR). Among lamotrigine‐induced patients with SJS/TEN, 11 (39.3%) patients tested positive for the HLA‐B*1502 while only 3 (12.0%) of the lamotrigine‐tolerant controls tested positive for this allele. The risk of lamotrigine‐induced SJS/TEN was significantly higher in patients with HLA‐B*1502, with an odds ratio (OR) of 4.74 [95% confidence interval (CI) 1.14–19.73, p = 0.032]. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HLA‐B*1502 for lamotrigine‐induced SJS/TEN was 39.29%, 88.00%, 78.57% and 56.41%, respectively. The HLA‐B*1502 allele was present in 2 (25.0%) of phenytoin‐induced SJS/TEN cases and 5 (41.7%) of the phenytoin‐tolerant controls tested positive for HLA‐B*1502 allele. The risk of phenytoin‐induced SJS/TEN was not higher in the patients with HLA‐B*1502 (OR = 0.467 [95% confidence interval (CI) 0.065‐3.34, p = 0.642]). Lamotrigine‐induced SJS/TEN is associated with HLA‐B*1502 allele in an Iranian population but this is not the case for phenytoin‐induced SJS/TEN.