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...

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Bibliographic Details
Main Authors: Carrel Ka Lung Yu, Chi Chiu Mok
Format: Article
Language:English
Published: World Scientific Publishing 2019-07-01
Series:Journal of Clinical Rheumatology and Immunology
Subjects:
Online Access:http://www.worldscientific.com/doi/epdf/10.1142/S2661341719300027
Description
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.
ISSN:2661-3417
2661-3425