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Temporal trends and patterns in carbamazepine use, related severe cutaneous adverse reactions, and HLA ‐B*15:02 screening: A nationwide study
Author(s) -
Lin ChihWan,
Huang WeiI,
Chao PiHui,
Chen WenWen,
Hsiao FeiYuan
Publication year - 2018
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.14599
Subject(s) - carbamazepine , medicine , adverse effect , pediatrics , epilepsy , psychiatry
Summary Objective After discovering the association between the HLA ‐B*15:02 allele and carbamazepine‐related severe cutaneous adverse reactions ( SCAR s), particularly in Southeastern Asian populations, clinical strategies to prevent carbamazepine‐related SCAR s have changed. We aimed to investigate 10‐year trends in carbamazepine use and carbamazepine‐related SCAR s and to examine the patterns and determinants of HLA ‐B*15:02 screening in Taiwan. Methods A nationwide study was performed using Taiwan’s National Health Insurance Research Database. In the first part of the study, new users of carbamazepine were included, and those who experienced SCAR ‐related admissions were further identified. In the second part of the study, recipients of HLA ‐B*15:02 screening (reimbursed by Taiwan’s National Health Insurance since June 2010) were included and multivariate logistic regression was used to explore factors associated with the use of screening. Results The numbers of new users of carbamazepine and SCAR cases decreased remarkably during the 10‐year period (−82.6% and −87.1%, respectively), and the incidence rates of SCAR s showed a downward trend after 2011. The screening rate of the HLA ‐B*15:02 allele increased to 24.9% in 2014. Neurologists (odds ratio 12.33, 95% confidence interval 9.30‐16.35), psychiatrists (9.97, 7.31‐13.61), and neurosurgeons (3.23, 2.42‐4.32) were more likely to perform screening tests than other specialties were. Physicians practicing in medical centers (6.00, 5.51‐6.54) were more likely to perform screening tests than those practicing in other hospitals, whereas the screening rates in clinics remained at 0.0% throughout the study period. Significance In recent years, the number of carbamazepine‐related SCAR cases has decreased substantially in Taiwan. However, only one‐fourth of new users of carbamazepine received HLA ‐B*15:02 screening, and there were considerable disparities in the screening rates across different physician groups. Policymakers should consider solutions to barriers to implementing screening tests in clinical practice and should not neglect the value of other safety communications and regulations to complement the limitations of pharmacogenomic testing.