The U.S. FDA now recommends that patients of Asian ancestry be screened for HLA-B*1502 prior to starting treatment with carbamazepine. While helpful, until the study by McCormack et al., clinicians were left with a great deal of uncertainty as to how to apply this information to other patient groups. Will screening for HLA-A*3101 prove to be as beneficial in patients of European (and perhaps Japanese) ancestry as it appears that HLA-B*1502 identification is in Han Chinese? Only additional prospective studies will be able to answer this. For now, however, it seems only reasonable that screening for HLA-A*3101 be strongly considered prior to initiation of carbamazepine in those patients. Clearly, much work remains to be done. Optimistically, one can now realistically envision a time when genomic profiling will lead to safer pharmacological management in patients with epilepsy.
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