Association of Oxcarbazepine-induced Cutaneous Adverse Drug Reactions with HLA-B*15:02 Allele

Pramote Euasobhon; Sukunya Jirachaipitak; Suwanna Chanpradub; Pranee Rushatamukayanunt; Chanin Limwongse; Peter Courtney

doi:10.33192/Smj.2020.23

Authors

Pramote Euasobhon Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0001-5268-5476
Sukunya Jirachaipitak Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0001-5188-3286
Suwanna Chanpradub Department of Anesthesiology, Bangkok Metropolitan Administration General Hospital, Bangkok http://orcid.org/0000-0002-4742-6725
Pranee Rushatamukayanunt Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0003-3596-3598
Chanin Limwongse Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0002-7374-6765
Peter Courtney Department of Anaesthesia, Royal Melbourne Hospital http://orcid.org/0000-0002-5607-2711

DOI:

https://doi.org/10.33192/Smj.2020.23

Keywords:

Antiepileptics; association; HLA-B*15:02; cutaneous adverse drug reactions; human leukocyte antigen; incidence; maculopapular eruption; oxcarbazepine; Stevens-Johnson syndrome

Abstract

Objective: Oxcarbazepine (OXC) has similar structure and efficacy to carbamazepine (CBZ), but with fewer side effects. However, there have been only a few reports of serious cutaneous adverse reactions to OXC. HLA-B*15:02’s association with cutaneous adverse drug reactions (cADRs) induced by OXC is still inconsistent. This study investigated the incidence of cADRs that were induced by OXC and their association with the HLA-B*15:02 allele in Thais.
Methods: A retrospective cohort study of 494 patients receiving oxcarbazepine between January 2012 and January 2018 was undertaken. HLA-B*15:02 testing had been carried out on 79 of the 494 patients.
Results: No incidents of serious cutaneous adverse reactions, Stevens-Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN) were found. A 2.4% (12/494) of OXC-related cADRs was determined. Four out of six patients with maculopapular eruptions (MPE) were HLA-B*15:02 positive. Patients who had the allele potentially developed OXC-induced MPE, with an odds ratio of 6.58 (95% CI 1.11-39.15, p=0.040). Only a history of other antiepileptic drug (AED) allergies demonstrated a significant risk factor of OXC-induced MPE.
Conclusion: Our research demonstrated that the association between the HLA-B*15:02 allele and MPE induced by OXC was significant. Patients with a history of other AED allergies were also at risk of developing OXC-induced MPE.

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