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Is HLAB genotyping the future of gout pharmacogenomics?

Nature Reviews Rheumatology volume 9, pages 200–202 (2013)Cite this article

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Pharmacogenomic advances have increased understanding of allopurinol-associated severe cutaneous adverse reactions (SCARs), demonstrating that HLAB*5801 is a strong risk factor for their development. In some populations, all patients with allopurinol-induced SCARs carry this allele. New treatment recommendations outline how this discovery should influence gout therapy, particularly the use of allopurinol.

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Figure 1: Schematic representation of the decision-making process for allocation of treatment to patients with gout based on the results of HLAB*5801 testing, according to recommendations made by Hershfield et al.4

References

  1. Pluim, H. J., van Deuren, M. & Wetzels, J. F. The allopurinol hypersensitivity syndrome. Neth. J. Med. 52, 107–110 (1998).

    Article  CAS  Google Scholar 

  2. Halevy, S. et al. Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J. Am. Acad. Dermatol. 58, 25–32 (2008).

    Article  Google Scholar 

  3. Cacoub, P. et al. The DRESS syndrome: a literature review. Am. J. Med. 124, 588–597 (2011).

    Article  CAS  Google Scholar 

  4. Hershfield, M. S. et al. Clinical Pharmacogenetics Implementation Consortium guidelines for human leukocyte antigen-B genotype and allopurinol dosing. Clin. Pharmacol. Ther. http://dx.doi.org/10.1038/clpt.2012.209.

  5. Zineh, I. et al. Allopurinol pharmacogenetics: assessment of potential clinical usefulness. Pharmacogenomics 12, 1741–1749 (2011).

    Article  CAS  Google Scholar 

  6. Khanna, D. et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. (Hoboken) 64, 1431–1446 (2012).

    Article  CAS  Google Scholar 

  7. Dalbeth, N. & Stamp, L. Allopurinol dosing in renal impairment: walking the tightrope between adequate urate lowering and adverse events. Semin. Dial. 20, 391–395 (2007).

    Article  Google Scholar 

  8. Stamp, L. K. et al. Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe starting dose of allopurinol. Arthritis Rheum. 64, 2529–2536 (2012).

    Article  CAS  Google Scholar 

  9. Tassaneeyakul, W. et al. Strong association between HLA-B*5801 and allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in a Thai population. Pharmacogenet. Genomics 19, 704–709 (2009).

    Article  CAS  Google Scholar 

  10. Obuchowski, N. A., Graham, R. J., Baker, M. E. & Powell, K. A. Ten criteria for effective screening: their application to multislice CT screening for pulmonary and colorectal cancers. AJR Am. J. Roentgenol. 176, 1357–1362 (2001).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The work of the author is supported by funding from the Agency for Health Research and Quality (AHRQ), Center for Education and Research on Therapeutics (CERTs), National Institute of Aging (NIA), National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) and the National Cancer Institute (NCI).

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  1. Department of Medicine and Epidemiology, University of Alabama, Faculty Office Tower 805B, 510 20th Street S., Birmingham, 35294, AL, USA

    Jasvinder A. Singh

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  1. Jasvinder A. Singh
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Competing interests

J. A. Singh has received grant/research support from the Savient and Takeda, and has acted as a consultant for Allergan, Ardea, Novartis, Regeneron, Savient, Takeda and URL Pharma.

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Singh, J. Is HLAB genotyping the future of gout pharmacogenomics?. Nat Rev Rheumatol 9, 200–202 (2013). https://doi.org/10.1038/nrrheum.2013.20

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