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The Thai Journal of Pharmaceutical Sciences

Abstract

Background: The HLA-B*58:01 allele is a significant genetic risk factor for allopurinol-induced cutaneous adverse drug reactions (CADRs), including mild and severe cutaneous adverse drug reactions(MCARs and SCARs, respectively). In Thailand, the HLA-B*58:01 screening test is not mandatory for all patients, resulting in suboptimal screening rates. In addition, there is a lack of studies on the impact of the screening test on clinical and economic outcomes. Objectives: This study aimed to determine if the HLA-B*58:01 screening test could prevent CADRs and reduce direct medical costs. Materials and Methods: This retrospective cohort study was conducted at Charoenkrung Pracharak Hospital in Bangkok. A total of 1026 available medical records of patients with gout or asymptomatic hyperuricemia, recorded between January 1, 2019, and December 31, 2023, were reviewed. The incidence of CADRs, MCARs, and SCARs among patients who underwent (study group) or did not undergo (comparison group) the test was compared. Results: There were 281 and 745 patients in the study and comparison group, respectively. In the study group, 53 patients had a positive outcome for HLA-B*58:01 and refrained from allopurinol, except for two cases that received the drug before the test, while 163 of the 228 who tested negative received allopurinol. All patients in the comparison group received allopurinol. The incidences of CADRs and MCARs in the study group were statistically lower than the comparison group (1.4% vs. 5.9%, P = 0.007, and 1.4% vs. 5%, P = 0.02, respectively). No significant differences in the incidence of SCARs were observed (0% vs. 0.9%; P = 0.216). The direct medical costs of the study group were less than the comparison group, for 2,128.43 US dollars per person. Conclusion: The screening of HLA-B*58:01 before initiating allopurinol effectively prevented allopurinol-induced CADRs and was cost-effective.

DOI

10.56808/3027-7922.2967

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