RESULTS OF A SCREENING SYSTEM WITH HLA-B*15:02 GENE TEST IN NEW PATIENTS REQUIRING CARBAMAZEPINE (CBZ): A CASE STUDY IN SAWAN-PRACHARAK HOSPITAL
DOI:
https://doi.org/10.69598/tbps.17.2.119-137Keywords:
carbamazepine (CBZ), new patients, gene test, adverse drug reactionAbstract
The development of an HLA-B*15:02 gene screening system for new patients requiring carbamazepine (CBZ) was studied in Sawan-pracharak hospital. This retrospective study was divided into 2 phases: pre- and post-development phase. Data were collected from the HOSxP version 4.0 system, the patient history record form, and satisfaction questionnaire. The results were analyzed with descriptive and analytical statistics. Sixty new CBZ-treated patients were identified and included in the study. It was found that before implementation of screening system, 24 from 31 patients were gene-screened (77.42%). One patient who had not started CBZ was reported to be positive for HLA-B*15:02. The incidence of adverse drug reactions (ADR) was 0.161. Five patients experienced ADR; 4 patients who had a negative gene screening test had non-serious ADR; 1 patient without gene testing experienced severe ADR. After implementation of the screening system with clear steps, responsible persons involved, and follow-up procedures including educating patients to observe prodrome symptoms, 29 new patients required initiation treatment with CBZ. Twenty eight (96.55%) patients were sent for genotyping. Five patients were reported to be positive for HLA-B*15:02. An ADR incidence was 0.206. Mild adverse reactions occurred in 6 patients who are negative for HLA-B*15:02. The turnaround time was reduced and the level of satisfaction of the healthcare workers was high. After the development of the HLA-B*15:02 gene screening system in new patients receiving CBZ, doctors and dentists began to recognize the importance of HLA-B*15:02 gene screening before they prescribed CBZ However, ADR related to CBZ could also occur in patients who had a negative HLA-B*15:02 gene test. Therefore, intensive ADR follow-up procedures should be implemented during initiation of CBZ therapy and upto 6 months. The continued follow-up after CBZ treatment is likely to be beneficial to the patients. However, this study did not examine other alleles such as HLA-B*15:21 or HLA-B*46:01 or HLA-B*13:01 that could contribute to other forms of ADR from CBZ.
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