Findings from a new study published in Seminars in Arthritis and Rheumatism show significant racial disparities in the risk of gout patients developing a serious, sometimes fatal adverse reaction to urate-lowering drugs.
Current treatment for gout includes dietary changes by reducing protein and alcohol intake, as well as anti-inflammatory, analgesic, and urate-lowering agents. Over 95% of the urate-lowering drug prescriptions in the U.S. are for allopurinol. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but severe cutaneous reactions can be fatal. Prior studies have linked the HLA-B*5801 variant with the risk of these reactions in particular Asian populations—including Korean, Japanese, Thai, and Han Chinese—and in some European populations.
Researchers from Massachusetts General Hospital conducted a study to see whether the frequency of the HLA-B*5801 variant among the races resulted in significant racial disparities in the risk of severe cutaneous reactions to urate-lowering drugs. Using 2009–2013 data from the Nationwide Inpatient Sample of the Agency for Healthcare Research and Quality, the study authors examined 606 hospitalizations with a principal diagnosis of SJS/TEN related to an adverse reaction of urate-lowering drugs.
Among the sample size, there was a greater representation of Asian and black patients vs. whites. Asians represented 2% of U.S. allopurinol users but comprised 27% of hospitalizations for SJS/TEN related to urate-lowering drugs. Similarly, black patients made up 13% of allopurinol users and 26% of hospitalizations. On the other hand, white patients made up 81% of allopurinol users but only 29% of hospitalizations; there was a very small number of Hispanic patients in the hospitalization database with the SJS/TEN diagnosis.
Overall, Asian patients faced a 12-fold higher risk and black patients faced a 5-fold higher risk of these severe cutaneous reactions vs. white patients; these differences were closely correlated with the frequency of HLA-B*5801 variant in these populations. Specifically, there was a 7.4% frequency among Asians, 4% among blacks, and 1% among both whites and Hispanics.
“Right now, we recommend testing for the HLA-B*5801 variant among those patients, and further research may help to identify additional factors that can improve risk management,” stated Hyon K. Choi, MD, DrPH, senior author the report.
For more information visit semarthritisrheumatism.com.