Genetic Testing of Gout Patients for Allopurinol Sensitivity: Who and How

The American College of Rheumatology's new guidelines on gout recommend that you consider genetic testing for patients of certain Asian backgrounds to clarify their risk for adverse reactions to allopurinol(Drug information on allopurinol). This is the first recommendation for use of the biomarker HLA-B*5801, says Dr. Robert Terkeltaub, co-principal investigator on the guidelines process.

In this podcast, Dr. Terkeltaub describes which patients should be considered for HLA-B*5801 testing, how to obtain the test, and what it means.

Dr. Terkeltaub is interim division chief for rheumatology, allergy, and immunology at the University of California San Diego and chief of the rheumatology section at the VA San Diego Healthcare System

Questions:

1.  Why isn't screening for the HLA-B*5801 marker recommended?
2.  Who is the genetic test appropriate for?
3.  How can a doctor recognize a patient of Han Chinese descent?
4.  Why do you think the FDA hasn't included this marker in its list of approved markers for drug sensitivity?
5.  How can a rheumatologist go about getting the test, and how much does it cost?
6.  Are there any special skills required to interpret the results?

SEE ALSO:  New ACR Gout Guidelines: What's Missing, What's New

For your reference:

1. Khanna D, Fitzgerald JP, Khanna PP et al. (2012) 

2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia

Arthritis Care & Research 64(10):1431–1446

2.  Zineh I, Mummanen P, Lyndly J et al. (2011) Allopurinol pharmacogenetics: assessment of potential clinical usefulness
Pharmacogenomics 12(12): 1741-1749