The HLA-B*15:02 polymorphism and Tegretol®-induced serious cutaneous reactions in epilepsy: An updated systematic review and meta-analysis.

Tegretol® [carbamazepine (CBZ)], an aromatic drug approved for epilepsy treatment, can induce adverse drug reactions (ADRs) after its administration. Several genetic studies of epilepsy have shown that genetic polymorphisms increase the risk of ADRs, and some interactions between CBZ and other treatments can also induce adverse effects. Thus, to avoid such interactions and to provide an overview of the genetic profiles involved in ADRs with CBZ, for the first time, a systematic review and meta-analysis focusing on epilepsy was performed, using Cochrane Library, Embase and PubMed databases to find studies published between January 1980 and October 2016. Of the eligible studies, those selected were related to the impact of genetic polymorphisms on ADRs in patients receiving antiepileptic treatment. The results of these selected studies are expressed as pooled odds ratios (ORs) with 95% confidence intervals (CIs), based on data from individual patients. Out of 807 articles, nine were included in the present meta-analysis to assess the association between human leukocyte antigen (HLA)-B*15:02 polymorphisms and CBZ-induced serious cutaneous reactions (SCRs), such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), in epilepsy. It was found that HLA-B*15:02 polymorphisms were significantly associated with CBZ SCR risk (OR: 27.325, 95% CI: 9.933-51.166), while subgroup analyses by ethnicity showed that the association was significant in Han Chinese (OR: 42.059, 95% CI: 9.587-184.514). The HLA-B*15:02 polymorphism was also strongly associated with the CBZ-SJS subgroup (OR: 152.089, 95% CI: 34.737-665.901) and significantly associated with the CBZ-SJS/TEN subgroup (OR: 13.993, 95% CI: 7.291-26.856). Also, the allele was overrepresented in the Han Chinese population (OR: 17.886, 95% CI: 8.411-38.034) within the CBZ-SJS/TEN subgroup. Although the number of studies available in other Asian ethnicities was insufficient for determining publication bias, it nevertheless showed a relationship between the HLA-B*15:02 polymorphism and SCRs. In addition, despite the small number of included studies, the results reveal strong evidence that the HLA-B*15:02 polymorphism can induce SCRs among Asian CBZ users. These findings should prompt physicians to individualize CBZ therapy for patients with epilepsy.

[Hepatitis B virus infection in Tunisia]. / Infection par le virus de l'hépatite B en Tunisie.

Recent reports show that the frequency of HBsAg varies around 4 to 6% in most Mediterranean and Middle East countries. Those areas are therefore considered as areas of intermediate endemicity for hepatitis B virus (HBV) infection. The purpose of this study is to investigate the HBV global situation in Tunisia, by means of third generation testing methods. Blood samples were obtained from 3 distinct population groups from Tunis: blood donors, consisting of young male adults staff members and patients from 4 haemodialysis units patients with either acute hepatitis or liver cirrhosis They were tested for HBsAg, anti-HBs and anti-HBc by radioimmunoassay tests. HBsAg was detected in 6.5% of the young male adults, and approximately 60% had either anti-HBs or anti-HBc antibodies. Haemodialysis staff members and patients respectively displayed 9.1% and 19.5% of HBsAg positivity, but an increase of HBsAg positivity and of all HBV serum markers in relation to the amount of time spent in dialysis units was shown among the patients. After 3 years of dialysis sessions, none remained seronegative. HBsAg was detected in approximately two-thirds of the patients with acute hepatitis or liver cirrhosis, and all cirrhosis patients had at least one HBV serum marker. These global results stress the importance of HBV infection in Tunisia. Immunization against hepatitis B virus therefore has to be considered. Nevertheless, the immunization strategy must take into account the epidemiological and economic characteristics of the country.