Specific ethnic genetic backgrounds are associated with the risk of Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN) especially in Asians. However, there have been no large cohort, multiple-country epidemiological studies of medication risk related to SJS/TEN in Asian populations. Thus, we analyzed the registration databases from multiple Asian countries who were treated during 1998-2017. A total 1,028 SJS/TEN cases were identified with the algorithm of drug causality for epidermal necrolysis. Furthermore, those medications labeled by the US Food and Drug Administration (FDA) as carrying a risk of SJS/TEN were also compared with the common causes of SJS/TEN in Asian countries. Oxcarbazepine, sulfasalazine, COX-II inhibitors, and strontium ranelate were identified as new potential causes. In addition to sulfa drugs and beta-lactam antibiotics, quinolones were also a common cause. Only one acetaminophen-induced SJS was identified, while several medications (e.g., oseltamivir, terbinafine, isotretinoin, and sorafenib) labeled as carrying a risk of SJS/TEN by the FDA were not found to have caused any of the cases in the Asian countries investigated in this study.
Background. Warts, caused by the human papilloma virus (HPV), are mucocutaneous proliferations controlled by cell-mediated immunity. Intralesional immunotherapy with measles, mumps, and rubella (MMR) vaccine, is postulated to induce a higher immune response for clearance of lesions.
Objective. To assess the efficacy, safety and effect on recurrence of intralesional MMR vaccine for the treatment of warts.
Methods. We searched online databases for randomized controlled trials on intralesional MMR vaccine for warts. Effects measured were the complete clearance of target and distant warts, adverse events noted and recurrence after treatment duration.
Results. Four RCTs comparing intralesional MMR vaccine and placebo were assessed. Meta-analysis showed a risk ratio of 0.24 [95% CI: 0.18, 0.34] favoring intralesional MMR vaccine and a highly significant difference in completely clearing target warts (P-value <0.00001) versus placebo. Three of the 4 trials assessed response of distant warts showing a risk ratio of 0.28 [95% CI: 0.08, 0.96] and a significant difference (P=0.04) versus placebo. Pain and flu-like symptoms were the most common side effects with no recurrence seen after 3-6 months.
Conclusions. Intralesional MMR vaccine significantly reduces and clears target and distant warts as compared to placebo. It is a generally safe intervention with lasting effect assessed up to 6 months follow-up.
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