Carbamazepine and Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in Thai and Han Chinese people (HLA-B*1502)

NICE gudiance notes that the Guideline Development Group are aware of the contraindications to prescribing carbamazepine (CBZ)to some people of Han Chinese or Thai origin (1)

CBZ has been reported to be associated with severe cutaneous adverse drug reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)

• postmarketing data provided by the leading CBZ manufacturer, revealed the incidence of CBZ-induced SJS/TEN in several Asian countries was 10-fold higher than those reported in European countries and the United States
  
  
• data from the World Health Organization Uppsala Monitoring Center (WHO-UMC) reveals reports of CBZ-associated SJS and TEN from the two Asian countries, Thailand and Malaysia, are far in excess of those from the predominantly European countries
  
  
• study evidence in Han Chinese showed that the HLA-B* 1502 allele is strongly associated with CBZ-induced SJS and TEN (2,3,4)
  • in contrast to the association reported in Han Chinese, the association between HLA-B*1502 and CBZinduced SJS/TEN could not be demonstrated in Caucasians (5)
    
    
• study evidence also shows that HLA-B*1502 is strongly associated with CBZ-induced TEN/SJS in the Malay population in Malaysia, as has been seen in Han Chinese in Taiwan (4)
  • the study authors concluded that " this indicates that the genetic association apparent in the incidence of CBZ-induced TEN/SJS is linked with the presence of HLA-B*1502, irrespective of racial origin. Screening of patients for this genetic marker can help to prevent the occurrence of TEN/SJS..."

Reference:

• NICE (April 2018). Epilepsies: diagnosis and management
• Tassaneeyakul W et al. Association between HLA-B*1502 and carbamazepine-induced severe cutaneous adverse drug reactions in a Thai population. Epilepsia. 2010 May;51(5):926-30
• Wang Q et al. Association between HLA-B*1502 allele and carbamazepine-induced severe cutaneous adverse reactions in Han people of southern China mainland. Seizure. 2011 Jul;20(6):446-8
• Chang CC et al. Association of HLA-B*1502 allele with carbamazepine-induced toxic epidermal necrolysis and Stevens-Johnson syndrome in the multi-ethnic Malaysian population.Int J Dermatol. 2011 Feb;50(2):221-4
• Lonjou C et al. A marker for Stevens-Johnson syndrome...: ethnicity matters. Pharmacogenomics J 2006;6:265-268.