Diagnostic Tests and Genetic Screening for Antiepileptic-Induced Severe Cutaneous Adverse Reactions (SCAR) in Resource Limited Setting
Keywords:
Pharmacogenomics, antiepileptics, SCAR, genetic screening, resource limited settingAbstract
Objective: Several antiepileptic drugs (AEDs) may cause a wide array of severe cutaneous adverse drug reactions, regardless of the severity of epilepsy among the users. SCARs may cause implications in patient outcomes including hospitalization and economic implications. Preventive efforts using genetic screening for HLA alleles have been proposed to identify patients with a high risk of developing SCAR. However, genotyping costs posed a challenge in our country with resource limited settings (RLS). The objective of this review is to describe several aspects of AED-induced SCARs including the diagnostic tests, genetic and non-genetic risk factors, and the economic burden of HLA allele screening. This information was then used to propose a workflow for HLA testing in RLS. Methods: Article search was carried out using PubMed/MEDLINE, Science Direct, Google Scholar and Cochrane library from the year 1990 until 2020 using the key words ‘cutaneous adverse drug reaction’, ‘genetic’, ‘epilepsy’, ‘antiepileptic’ and ‘HLA gene’. Results: Genetic predisposition is not the only factor associated with the incidence of SCARs. Stratifying the patients according to non-genetic risk factors, for example age, may provide a more selective screening for HLA alleles in RLS. HLA-B*15:02 screening before starting AEDs in Malaysia might be cost-effective when taking into account the shrinking cost-effectiveness threshold in our country, although, more pharmacoeconomic data are needed to draw a conclusion. Conclusion: Selected patient screening for HLA allele can be introduced in RLS in the prevention of AED-induced SCARs.
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