HLA-B*5901 is Strongly Associated with Methazolamide-Induced Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis

Abstract

Aims: The carbonic anhydrase inhibitor methazolamide infrequently causes Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). An association between these diseases and the HLA-B59 serotype has been suggested in case reports. This study examined the disease-associated B*59 allele and investigated the association of these diseases with other HLA class I alleles. Methods: We performed high-resolution HLA-A, -B and -C genotyping in five patients with methazolamide-induced SJS/TEN using a PCR-sequencing-based typing method and analyzed the association between HLA-class I alleles and occurrence of methazolamide-induced SJS/TEN. Results:B*5901 and Cw*0102 alleles were observed in all patients and A*2402 was observed in four patients. The B*5901 allele showed the strongest association with methazolamide-induced SJS/TEN (p < 0.001; odds ratio: 249.8; 95% CI: 13.4–4813.5), followed by Cw*0102 (p = 0.004; odds ratio: 22.1; 95% CI: 1.2–414.3), when compared with the general population as a control. The frequency of the patients carrying B*5901, Cw*0102 and A*2402 simultaneously was significantly higher than that in the general population (p < 0.001; odds ratio: 110.1; 95% CI: 11.7–1038.6). Conclusion: A strong association was observed between HLA-B*5901 and methazolamide-induced SJS/TEN in Korean patients. HLA-B*5901 may be a useful screening marker for predicting methazolamide-induced SJS/TEN in patients of Korean and Japanese ancestry.

KEYWORDS::

• carbonic anhydrase inhibitor
• human leukocyte antigen
• methazolamide
• Stevens–Johnson syndrome
• toxic epidermal necrolysis

Financial & competing interests disclosure

This study was supported by a grant of the Korean Health 21 R&D Project, Ministry of Health, Welfare and Family Affairs, Republic of Korea (A030001). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

This study was supported by a grant of the Korean Health 21 R&D Project, Ministry of Health, Welfare and Family Affairs, Republic of Korea (A030001). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.