Carbamazepine and phenytoin induced Stevens‐Johnson syndrome is associated with HLA‐B1502 allele in Thai population

• Published in: Epilepsia (Copenhagen) Vol. 49; no. 12; pp. 2087 - 2091
• Main Authors: Locharernkul, Chaichon, Loplumlert, Jakrin, Limotai, Chusak, Korkij, Wiwat, Desudchit, Tayard, Tongkobpetch, Siraprapa, Kangwanshiratada, Oratai, Hirankarn, Nattiya, Suphapeetiporn, Kanya, Shotelersuk, Vorasuk
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2008
• Subjects: Adolescent; Adult; Anticonvulsants - adverse effects; Carbamazepine; Carbamazepine - adverse effects; Child; Epilepsy - drug therapy; Epilepsy - genetics; Female; Genetic Predisposition to Disease - ethnology; HLA-B Antigens - genetics; HLA‐B1502; Humans; Maculopapular eruption; Male; Middle Aged; Pharmacogenetics; Phenytoin; Phenytoin - adverse effects; Retrospective Studies; Stevens-Johnson Syndrome - chemically induced; Stevens-Johnson Syndrome - genetics; Stevens‐Johnson syndrome; Thai; Thailand - ethnology; Young Adult; Thailand
• ISSN: 0013-9580; 1528-1167; 1528-1167
• DOI: 10.1111/j.1528-1167.2008.01719.x

Summary Purpose:  Previous studies found a strong association between HLA‐B*1502 and carbamazepine (CBZ)‐induced Stevens‐Johnson syndrome (SJS) in Han Chinese, but not in Caucasian populations. Even in Han Chinese, the HLA‐B*1502 was not associated with CBZ‐induced maculopapular eruptions (MPE). This study seeks to identify whether HLA‐B*1502 is associated with CBZ‐ or phenytoin (PHT)‐induced SJS or MPE in a Thai population. Methods:  Eighty‐one Thai epileptic patients between 1994 and 2007 from the Chulalongkorn Comprehensive Epilepsy Program were recruited. Thirty‐one subjects had antiepileptic drug (AED)‐induced SJS or MPE (6 CBZ‐SJS, 4 PHT‐SJS, 9 CBZ‐MPE, 12 PHT‐MPE), and 50 were AED‐tolerant controls. Results:  For the first time, a strong association between HLA‐B*1502 and PHT‐induced SJS was found (p = 0.005). A strong association was also found between the HLA‐B*1502 and CBZ‐induced SJS (p = 0.0005), making Thai the first non‐Chinese population demonstrating such an association. Some patients, who were HLA‐B*1502 and suffered from CBZ‐induced SJS, could be tolerant to PHT and vice versa. This suggests that HLA‐B*1502 may be a common attribute required for a Thai patient to develop SJS from these two AEDs; other different elements, however, are also needed for each AED. In addition, no association between HLA‐B alleles and CBZ‐ or PHT‐induced MPE was found. Conclusions:  CBZ‐ and PHT‐induced SJS, but not MPE, is associated with HLA‐B*1502 allele in Thai population.