Change of Eligibility Criteria for Screening of the HLA-B*58:01 Allele in New Patients with Indications for Allopurinol to Prevent Severe Cutaneous Adverse Reactions in Thasongyang Hospital
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Abstract
Objectives: To improve the screening for the HLA-B*58:01 allele in new patients with indications for allopurinol by changing eligible criteria, to study its effect on the proportion of patients being screened and to compare the detection rate of the HLA-B*58:01 allele between Thai patients and ethnic group patients, and between male and female patients at Thasongyang Hospital. Methods: The study changed eligible criteria by allowing all new patients with an indication for allopurinol to be screened. All physicians were able to order the screening test for all patients in any health benefit schemes. The study compared proportion of new patients with indications for allopurinol who were genetically screened for the HLA-B*58:01 allele before the change (January 1, 2021 to December 31, 2023) and after the change (January 1 to May 31, 2024). The study also compared the detection rate of the HLA-B*58:01 allele between Thai and ethnic patients, and between males and females. Results: After changing eligible criteria, the patients with genetic screening significantly increased from 34.8% (54/155 cases) to 97.4% (37/38 cases) (P < 0.001). Four out of 54 screened cases (7.4%) patients with the HLA-B*58:01 allele were detected before the change of criteria, and one out of 37 screened cases (2.7 percent) was detected after the change of criteria. Among 91 screened patients included 44 Thai patients with 5 of them having the HLA-B*58:01 allele (11.4% of Thai patient group and 5.5% of all screened patients). Of the 47 ethnic group patients, the allele was detected in 0 case. The detection of the allele was significantly higher in Thai patients compared to that in ethnic group (P = 0.017). Proportions of patients with allele detected for both males and females were 5.7% and 4.8%, respectively but not reaching statistically significant level (P = 0.867). Conclusion: Changing of the screening criteria helps more patients gain access to the test for the HLA-B*58:01 allele before starting allopurinol. Thai patients were detected with the HLA-B*58:01 allele more than ethnic patients. Males and females were found to be no different in the detection rate. This process should be applied to the screening for HLA-B alleles associated with severe adverse skin reactions in other drugs.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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