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HLA-B38, DR4, DQw3 and Clozapine-Induced Agranulocytosis in Jewish Patients With Schizophrenia
Jeffrey A. Lieberman, MD;
Juan Yunis, MD;
Eduardo Egea, MD;
Rosa T. Canoso, MD;
John M. Kane, MD;
Edmond J. Yunis, MD
Arch Gen Psychiatry. 1990;47(10):945-948.
Abstract
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• Agranulocytosis develops in approximately 1% of patients with chronic schizophrenia treated with the atypical neuroleptic drug clozapine. Previous studies have not identified the mechanism or risk factors for this adverse reaction. Because of an observed association between Jewish ethnic background and the development of agranulocytosis in our patient sample treated with clozapine for refractory symptoms, HLA typing was performed in 31 patients (19.4% of whom had developed agranulocytosis). The HLA-B38 phenotype was found in 83% of patients who developed agranulocytosis and in 20% of clozapine-treated patients who did not develop agranulocytosis. Because B38 is part of a haplotype known to occur frequently in the Ashkenazi Jewish population, the frequencies of the combined alleles HLA-B38, DR4 and DQw3 were examined. The incidence of HLA-B38, DR4, DQw3 was significantly increased in patients with agranulocytosis (five of five patients) compared with control patients of Ashkenazi Jewish ancestry (two of 17 patients). These findings indicate that genetic factors marked by major histocompatibility complex haplotypes may be associated with the susceptibility of Jewish schizophrenic patients treated with clozapine to develop agranulocytosis. We postulate that gene products contained in the haplotype may be involved in mediating drug toxicity.
Author Affiliations
From the Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, Glen Oaks, NY (Drs Lieberman and Kane); Hematology/Oncology Section, Brock-West Roxbury, Department of Veterans Affairs Medical Center (Dr Canoso) and the Division of Immunogenetics, Dana-Farber Cancer Institute, Department of Pathology, Harvard Medical School, Boston, Mass (Drs J. Yunis, Egea, and E. J. Yunis).
Footnotes
Accepted for publication June 6, 1990.
Reprint requests to Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center, PO Box 38, Glen Oaks, NY 11004 (Dr Lieberman).
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