Question 2 Should phenytoin and carbamazepine be avoided in Asian populations with the HLA-B*1502 positive genetic variant? | Archives of Disease in Childhood

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Article Text

Archimedes

Question 2 Should phenytoin and carbamazepine be avoided in Asian populations with the HLA-B*1502 positive genetic variant?

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Subramanian Ganesan,
Nahin Hussain

Department of Paediatric Neurology, University Hospitals of Leicester NHS Trust, Leicester, UK

Correspondence to Subramanian Ganesan, Department of Paediatric Neurology, University Hospitals of Leicester NHS Trust, Leicester, UK; priyasubbu2002{at}hotmail.com

https://doi.org/10.1136/adc.2010.190454

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Scenario

Recently, Drug Safety Update (a monthly newsletter from the Medicines and Healthcare products Regulatory Agency (MHRA) and the UK Commission on Human Medicines) issued an alert on the antiepileptic drug (AED) phenytoin (PHT) regarding an increased risk of Steven–Johnson syndrome (SJS) associated with the presence of the HLA-B*1502 genetic variant in patients of Asian origin.1 Likewise, the US Federal Drug Agency (FDA) recommended genotyping for the allele in all Asian patients before starting carbamazepine (CBZ).2 We wanted to explore the implications of this for our clinical practice.

Structured clinical question

In children with epilepsy who are known to be positive for HLA-B*1502 [patient], do we need to avoid PHT and CBZ for fear of severe skin reactions [intervention] and do we need to screen children of Asian origin for the specific allele before starting on the AEDs [outcome]?

Search strategy

Primary sources

EMBASE and PubMed were searched using the term ‘HLA-B*1502 AND cutaneous reactions AND antiepileptic drugs’.

Secondary sources

Four case–control studies were identified and included for further appraisal (see table 2)

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Table 2

Should phenytoin and carbamazepine be avoided in Asian populations with the HLA-B*1502 positive genetic variant?

Commentary

Epilepsy is the most common neurological condition affecting all ages, races and social classes and there …