Genetic testing for prevention of severe drug-induced skin rash

Alfirevic, Ana; Pirmohamed, Munir; Marinović, Branka; Harcourt-Smith, Linda; Jorgensen, Andrea; Cooper, Tess E

doi:10.1002/14651858.cd010891.pub2

Cited by 8 publications

(3 citation statements)

References 80 publications

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“…40 However, there are no studies that support the validity of pre-screening in improving the prevention of the SCAR. 41 Although complications such as lip synechiae have been reported, generally there are no active preventative guidelines as part of the treatment strategy. As part of the treatment strategy for SJS/TEN patients, Valeyrie-Allanore et al 42 recommends daily lubrication of mucosal surfaces with an emollient to prevent adhesions.…”

Section: Discussionmentioning

confidence: 99%

“…As a preventative measure, the Food and Drug Administration recommends that patients with possible HLA‐B*1502 ancestry or are from an area with HLA‐B*1502 predominance should be screened before the initiation of triggering drugs 40 . However, there are no studies that support the validity of pre‐screening in improving the prevention of the SCAR 41 . Although complications such as lip synechiae have been reported, generally there are no active preventative guidelines as part of the treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

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Lip synechiae: A sequelae of carbamazepine‐induced erythema multiforme. A case report and review of current perspectives and controversies

Nokaneng

2023

Oral Surgery

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Lip synechiae as a sequalae of erythema multiforme (EM) is rare. However, the condition results in significant dysfunctionality and disfigurement in affected individuals. The objective of this clinical case report is to highlight the importance of the preventative strategies in carbamazepine‐induced EM to alleviate complications such as lip synechiae. We reviewed a case report of lip synechiae as a sequelae of carbamazepine‐induced EM as well as the previously reported cases of lip synechiae. A 23‐year‐old female presented with the inability to open her mouth following carbamazepine exposure with concomitant eruption of mucocutaneous lesions on the torso, acral, conjunctiva and haemorrhagic crusting on both lips with fusion thereof. The lip synechiae resulted in dysfunction and disfigurement with reduced verbal articulation and mastication. Based on the history and the characteristic appearance of the mucocutaneous lesions, a diagnosis of EM was made. The suspected inciting drug was withdrawn followed by bilateral chalinoplasty. To prevent further adhesion of the lips, chlorhexidine‐impregnated paraffin gauze dressing was applied. The patient attained good functional and aesthetic outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lip synechiae: A sequelae of carbamazepine‐induced erythema multiforme. A case report and review of current perspectives and controversies

Nokaneng

2023

Oral Surgery

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“…16 PGx testing has been shown to reduce ADRs, reduce the frequency of hospital admissions, and to improve treatment response. [17][18][19][20] In Switzerland, preemptive PGx testing is only reimbursed by basic health care insurances in the context of a pharmacotherapy with abacavir (human leukocyte antigen (HLA) -B*5701), carbamazepine (HLA-A*3101 and HLA-B*1502), 6-mercaptopurine and azathioprine (thiopurine S-methyltransferase (TPMT)), 5-fluorouracil and capecitabine (dihydropyrimidine dehydrogenase (DPYD)), and irinotecan (UDP glucuronosyltransferase (UGT) 1A1*28). 21 Even though the insurers are private companies, the Federal Office of Public Health dictates, which services and medications they have to cover in the basic health care insurance.…”

Section: Introductionmentioning

confidence: 99%

Utilization of Drugs with Pharmacogenetic Dosing Recommendations in Switzerland: A Descriptive Study Using the Helsana Database

Wittwer¹,

Meier²,

Huber³

et al. 2022

PGPM

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Purpose In Switzerland 167 drugs on the market contain information about pharmacogenetics in their drug label (PGx drug). Preemptive pharmacogenetic testing is reimbursed by health care insurance for only seven drugs (abacavir, carbamazepine, 6-mercaptopurine, azathioprine, 5-fluorouracil, capecitabine, and irinotecan) although, it is proposed to be a cost-effective approach to personalized medicine. The aim of this study was to describe the use of PGx drugs and their corresponding genes in Switzerland. Methods We identified 90 drugs with dosing recommendations from the Pharmacogenetic Knowledgebase involving 24 genes. We assessed the utilization of those drugs between 2016 and 2020, using claims data from a large Swiss insurance company (Helsana). Results Of 841 491 persons with drug claims during the whole study period, 78.7% were exposed to PGx drugs. Ibuprofen, pantoprazole, and tramadol had the highest number of users. Seven genes ( CYP2C19, CYP2C9, CYP2D6, SLCO1B1, HLA-B, MT-RNR1 , and VKORC1 ) were responsible for over 95% of all potential drug-gene interactions. Conclusion The prevalence of PGx drug prescriptions is high in the Swiss population. Therefore, intensified preemptive testing may be a useful option as a substantial amount of the Swiss population might benefit.

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