Do HLA-A markers predict skin-reactions from aromatic antiepileptic drugs in a Norwegian population? A case control study.

Abstract

PURPOSE:

Cutaneous adverse reactions (cADRs) from carbamazepine (CBZ) have been associated with human leukocyte antigens (HLA). Our aims were to assess the clinical usefulness of HLA-A*31:01 as a predictor of CBZ-induced cADRs in the Norwegian population and to explore whether cADRs from aromatic antiepileptic drugs (AEDs) in general might be linked with a common HLA-A-marker.

MATERIALS AND METHODS:

86 ethnic Norwegians with a history of non-bullous cADRs from aromatic AEDs were included. 114 subjects tolerant to at least one aromatic AED were used as drug-specific controls. Complete HLA-A genotyping was performed. 1026 blood donors were used as population controls.

RESULTS:

Comparing all cADR subjects with controls and blood donors, there were no statistical differences for any HLA-A allele, except for HLA-A*24 (p=0.022 vs. controls and p=0.014 vs. blood donors). When comparing tolerant controls with patients having had a cADR to one of the two most used drugs, CBZ (n=48) and lamotrigine (n=28), we found no significant associations for CBZ to HLA-A*31:01 or HLA-A*24:02, but for lamotrigine there was an association with HLA-A*24:02 (p=0.027). In patients developing cross-reactivity (n=14) to aromatic AEDs, the presence of HLA-A*31:01 or HLA-A*24:02 was not different compared to patients with a single cARD tolerant to at least one other drug.

CONCLUSION:

We question the clinical usefulness of HLA-A*31:01 as a marker for CBZ rash in the Norwegian population. A previously suggested protective effect of aromatic AED cross-reactivity from HLA-A*24:02 was not confirmed. The association between HLA-A*24:02 and lamotrigine-induced rash should be further investigated.

• Authors: Maryam Shirzadi, Ketil Thorstensen, Grethe Helde, Torolf Moen, Eylert Brodtkorb
• Journal: Epilepsy research (Epilepsy Res) Vol. 118 Pg. 5-9 (Dec 2015) ISSN: 1872-6844 [Electronic] Netherlands
• PMID: 26555631 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier B.V. All rights reserved.

Chemical References

• Anticonvulsants
• HLA-A*03:01 antigen
• HLA-A*24:02 antigen
• HLA-A24 Antigen
• HLA-A3 Antigen
• Triazines
• Carbamazepine
• Lamotrigine

Topics

• Adult
• Anticonvulsants (adverse effects)
• Carbamazepine (adverse effects)
• Case-Control Studies
• Cross Reactions
• Epilepsy (drug therapy)
• Female
• Genetic Predisposition to Disease (genetics)
• HLA-A24 Antigen (genetics)
• HLA-A3 Antigen (genetics)
• Humans
• Lamotrigine
• Male
• Norway
• Triazines (adverse effects)
• Vasculitis, Leukocytoclastic, Cutaneous (chemically induced, genetics)
• White People (genetics)