Local researchers discovered that by identifying the genotype of individuals, severe cutaneous adverse reactions (SCAR) induced by taking allopurinol — a common drug for decreasing uric acid levels — can be prevented.
The research team led by Taipei Veterans General Hospital allergy, immunology and rheumatology Department physician Tsai Chang-Youh (蔡長祐), the Institute of Biomedical Sciences at Academia Sinica and 15 other hospitals across the nation, discovered that the HLA-B*5801 allele can be a genetic marker for allopurinol-SCAR.
Academia Sinica Institute of Biomedical Sciences research fellow Shen Chih-yang (沈志陽) said allopurinol is commonly prescribed to treat gout and hyperuricemia — an abnormally high level of uric acid in the blood — but it is one of the most frequent causes of adverse drug reactions.
Data from Taipei Veterans General Hospital showed 38 cases of allopurinol-SCAR between 1980 and 1993, he said, adding that nine had died — about a 24 percent death rate — and the main cause was infection.
Shen said allopurinol-SCAR has been known to cause acute liver failure, drug hypersensitivity syndrome and skin conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, skin rashes, erythema multiforme, skin eruptions and exfoliative dermatitis.
The research was conducted among 2,910 patients, of which 2,339, or 80.4 percent, tested negative for the genetic marker HLA-B*5801 and were given allopurinol, Tsai said.
The 571, or 19.6 percent, who tested positive for HLA-B*5801 were given an alternative medicine, Tsai said.
Results showed that no patients suffered from allopurinol-SCAR during the study.
The study indicated that allopurinol-SCAR is strongly associated with a genetic predisposition, Tsai said, adding that genetic testing prior to prescribing allopurinol could reduce the risk of adverse reactions.
He said the prevalence of hyperuricemia is about 20 to 25 percent among men and about 14 to 15 percent among women nationally, and allopurinol is still the most commonly prescribed treatment for the condition because it is relatively cheap and the alternative treatment, febuxostat, which is not covered by the National Health Insurance, except in special circumstances.
Tsai said the expense of genetic testing for HLA-B*5801 is not covered by the NHI at present, and might cost NT$2,000 to NT$3,000 at different hospitals, but the team said that the inclusion of genetic testing as a conventional exam prior to prescribing annopurinol would improve the nation’s drug safety and medical standards.
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