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An alarm system of carbamazepine-induced toxic effects highly associated with HLA-B*1502 allele Carbamazepine is widely used in epilepsy, trigeminal neuralgia, and bipolar disorder, but if it causes severe cutaneous adverse reactions including Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), and the mortality rate is as high as 30%.1 Because of the death of patient taking carbamazepine due to this serious adverse drug reaction in our hospital, we read the article "Carbamazepine-induced Toxic Effects and HLA-B1502* Screening in Taiwan" by Chen et al, and learned that this toxic reaction was strongly correlated with the HLA-B*1502 allele, and compared with other ethnic groups, this genotype is the highest proportion in Asian population.2 Therefore, this article recommended that Asian patients should undergo HLA-B*1502 genetic screening before taking carbamazepine to avoid serious adverse drug reactions caused by this drug. Therefore, we, located in Southeast Asia-Taiwan, are motivated to get actively involved in building a computer-based alarm system for carbamazepine and HLA-B*1502 allele cross matching. [Extracted from the article]

Objective: β-Blockers are safe and improve survival in patients with both congestive heart failure (CHF) and COPD. However, the superiority of different types of β-blockers is still unclear among patients with CHF and COPD. The association between β-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different β-blockers in patients with concurrent CHF and COPD., Patients and Methods: We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were >20 years old and were diagnosed with CHF between January 1, 2005 and December 31, 2012. COPD patients included those who had outpatient visit claims ≥2 times within 365 days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of β-blockers in the study population., Results: We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR] =0.51, 95% confidence interval [CI] =0.29-0.89; hospitalization rate due to CHF exacerbation: aHR =0.48, 95% CI =0.23-1.00). No association was observed between β-blocker use and COPD exacerbation., Conclusion: In patients with concurrent CHF and COPD, β-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was found to reduce mortality and CHF exacerbation compared to carvedilol and metoprolol., Competing Interests: Disclosure The authors report no conflicts of interests in this work.