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JAMA Dermatol. 2018 Dec 1;154(12):1424-1431. doi: 10.1001/jamadermatol.2018.3679.

Association of APOA5 and APOC3 Genetic Polymorphisms With Severity of Hypertriglyceridemia in Patients With Cutaneous T-Cell Lymphoma Treated With Bexarotene.

Author information

Cardiovascular Risk Unit, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
Clinical Genetics Laboratory, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
Dermatology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain.
Dermatology Department, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
Dermatology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
Dermatology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
Dermatology Department, Hospital General Universitario de Valencia, Valencia, Spain.
Dermatology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain.
Dermatology Department, Hospital Universitario de Basurto, Bilbao, Spain.
Dermatology Department, Hospital del Mar, IMIM, Barcelona, Spain.
Dermatology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
Dermatology Department, Hospital Nuestra Señora del Prado, Talavera, Spain.
Dermatology Department, Hospital Arnau de Vilanova, Lleida, Spain.
Dermatology Department, Hospital Universitario 12 de Octubre, Institute i+12, CIBERONC, Medical School, University Complutense, Madrid, Spain.



Hypertriglyceridemia is the most frequent and limiting adverse effect of bexarotene therapy in cutaneous T-cell lymphoma (CTCL). Despite standard prophylactic measures, there is a wide variability in the severity of this complication, which could be associated with both genetic and environmental factors.


To analyze the association between genetic polymorphisms of apolipoprotein genes APOA5, APOC3, and APOE and the severity of hypertriglyceridemia during bexarotene therapy and to optimize patient selection for bexarotene therapy based on adverse effect profile.

Design, Setting, and Participants:

This case series study was conducted in 12 university referral hospitals in Spain from September 17, 2014, to February 6, 2015. One hundred twenty-five patients with a confirmed diagnosis of CTCL who had received bexarotene therapy for at least 3 months were enrolled. Nine patients were excluded owing to missing analytic triglyceride level data, leaving a study group of 116 patients. Data on demographic and cardiovascular risk factor were collected, and a complete blood analysis, including lipid profile and genetic analysis from a saliva sample, was performed.

Main Outcomes and Measures:

Primary outcomes were the maximal triglyceride levels reported in association with the minor alleles of the polymorphisms studied.


Among 116 patients, the mean (SD) age was 61.2 (14.7) years, 69 (59.5%) were men, and 85 (73.2%) had mycosis fungoides, the most prevalent form of CTCL. During bexarotene therapy, 96 patients (82.7%) experienced hypertriglyceridemia, which was severe or extreme in 8 of these patients (8.3%). Patients who carried minor alleles of the polymorphisms did not show significant differences in baseline triglyceride concentrations. After bexarotene treatment, carriers of at least 1 of the 2 minor alleles of APOA5 c.-1131T>C and APOC3 c.*40C>G showed lower levels of triglycerides than noncarriers (mean [SD], 241.59 [169.91] vs 330.97 [169.03] mg/dL, respectively; P = .02).

Conclusions and Relevance:

These results indicate that the screening of APOA5 and APOC3 genotypes may be useful to estimate changes in triglyceride concentrations during bexarotene treatment in patients with CTCL and also to identify the best candidates for bexarotene therapy based on the expected adverse effect profile.

[Indexed for MEDLINE]
Free PMC Article

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