Clinical Usefulness of HLA-B∗58:01 Genotyping in Gouty Arthritis
Allopurinol is an effective urate lowering agent but may lead to rare but life-threatening severe cutaneous adverse reactions (SCAR). Genetic predisposition, age, sex, renal function, dosage and concomitant diuretic use are known risk factors of allopurinol related SCAR. Among these factors, HLA-B∗5...
Main Authors: | , |
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Format: | Article |
Language: | English |
Published: |
World Scientific Publishing
2019-07-01
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Series: | Journal of Clinical Rheumatology and Immunology |
Subjects: | |
Online Access: | http://www.worldscientific.com/doi/epdf/10.1142/S2661341719300027 |
Summary: | Allopurinol is an effective urate lowering agent but may lead to rare but life-threatening severe cutaneous adverse reactions (SCAR). Genetic predisposition, age, sex, renal function, dosage and concomitant diuretic use are known risk factors of allopurinol related SCAR. Among these factors, HLA-B∗58:01 confers the highest risk. Frequency of the HLA-B∗58:01 allele varies significantly across different ethnic groups. Although the usefulness of HLA-5801 genotyping before initiation of allopurinol has been confirmed by clinical studies, its positive predictive value for SCAR is low because of the low prevalence of HLA-5801 in some localities. Thus, health economic analysis does not consistently show cost-effectiveness of universal screening of HLA-5801 before initiation of allopurinol. However, screening of this genotype in high-risk subjects, including those with renal impairment or advanced age, should be considered on individual basis. |
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ISSN: | 2661-3417 2661-3425 |