PMID- 28857441
OWN - NLM
STAT- MEDLINE
DCOM- 20180611
LR  - 20211204
IS  - 1756-185X (Electronic)
IS  - 1756-1841 (Linking)
VI  - 20
IP  - 9
DP  - 2017 Sep
TI  - Diagnostic utility of HLA-B*5801 screening in severe allopurinol hypersensitivity 
      syndrome: an updated systematic review and meta-analysis.
PG  - 1057-1071
LID - 10.1111/1756-185X.13143 [doi]
AB  - BACKGROUND: Despite many studies suggesting an association between human 
      leukocyte antigen (HLA)-B*5801 and allopurinol-induced toxic epidermal necrolysis 
      (TEN) and Stevens-Johnsons syndrome (SJS), the evidence of association in 
      different populations and the degree of association remain uncertain. METHODS: 
      The primary analysis was based on population-control studies. Data were pooled by 
      means of a random-effects model, and sensitivity, specificity, positive 
      likelihood ratios (LR+), negative likelihood ratios (LR-), diagnostic odds ratios 
      (DOR), and areas under summary receiver operating characteristic (SROC) curves 
      (AUC) were calculated. RESULTS: In nine population-control studies, HLA-B*5801 
      was measured in 162 patients with allopurinol-induced TEN/SJS and 7372 patients 
      without allopurinol-induced TEN/SJS. The pooled sensitivity, specificity, LR+, 
      LR-, DOR and AUC were 0.78 (95% CI = 0.71-0.85), 0.96 (95% CI = 0.96-0.97), 14.23 
      (95% CI = 7.89-25.63), 0.29 (95% CI = 0.16-0.54), 83.5 (95% CI = 50.7-137.4), and 
      0.97 (95% CI = 0.95-0.99), respectively. Subgroup analyses of the DORs for 
      Chinese, Japanese, and Caucasian populations yielded similar findings for Chinese 
      (196.1; 95% CI = 57.3-672.0), Japanese (78.8; 95% CI = 30.4-203.9), and Caucasian 
      (58.4; 95% CI = 16.9-201.5) populations. Overall, HLA-B*5801 was associated with 
      allopurinol-induced TEN/SJS in European and Japanese populations, but only had a 
      50-60% sensitivity (pooled sensitivity 56%), compared to the 80-100% sensitivity 
      (pooled sensitivity 97%) observed in Korean, Thai, Sardinia Italian and Han 
      Chinese populations. CONCLUSIONS: The present study reveals that allopurinol is 
      the leading cause of TEN/SJS in many countries. In contrast to carbamazepine, 
      which is ethnic/population specific, the HLA-B*5801 for detecting 
      allopurinol-induced TEN/SJS is universal. Screening of HLA-B*5801 may help 
      patients to prevent the occurrence of allopurinol-induced TEN/SJS, especially in 
      populations with a higher (>/= 5%) risk allele frequency.
CI  - (c) 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons 
      Australia, Ltd.
FAU - Yu, Kuang-Hui
AU  - Yu KH
AUID- ORCID: 0000-0001-6251-0231
AD  - Center for Evidence-based Medicine, Division of Rheumatology, Allergy and 
      Immunology, Department of Internal Medicine, Chang Gung University, Tao-Yuan, 
      Taiwan.
AD  - Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, 
      Tao-Yuan, Taiwan.
FAU - Yu, Cheng-Yen
AU  - Yu CY
AD  - Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, 
      Tao-Yuan, Taiwan.
FAU - Fang, Yao-Fan
AU  - Fang YF
AD  - Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, 
      Tao-Yuan, Taiwan.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170831
PL  - England
TA  - Int J Rheum Dis
JT  - International journal of rheumatic diseases
JID - 101474930
RN  - 0 (Enzyme Inhibitors)
RN  - 0 (Gout Suppressants)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-B*58:01 antigen)
RN  - 63CZ7GJN5I (Allopurinol)
SB  - IM
MH  - Allopurinol/*adverse effects
MH  - Area Under Curve
MH  - Chi-Square Distribution
MH  - Enzyme Inhibitors/*adverse effects
MH  - Gene Frequency
MH  - Genetic Predisposition to Disease
MH  - Genetic Testing/*methods
MH  - Gout Suppressants/*adverse effects
MH  - HLA-B Antigens/*genetics/immunology
MH  - Humans
MH  - Odds Ratio
MH  - Phenotype
MH  - Predictive Value of Tests
MH  - ROC Curve
MH  - Racial Groups
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Stevens-Johnson Syndrome/diagnosis/ethnology/*genetics/immunology
OTO - NOTNLM
OT  - HLA-B*5801
OT  - allopurinol
OT  - gout
OT  - hypersensitivity
OT  - meta-analysis
OT  - screening
EDAT- 2017/09/01 06:00
MHDA- 2018/06/12 06:00
CRDT- 2017/09/01 06:00
PHST- 2017/09/01 06:00 [pubmed]
PHST- 2018/06/12 06:00 [medline]
PHST- 2017/09/01 06:00 [entrez]
AID - 10.1111/1756-185X.13143 [doi]
PST - ppublish
SO  - Int J Rheum Dis. 2017 Sep;20(9):1057-1071. doi: 10.1111/1756-185X.13143. Epub 
      2017 Aug 31.