A Cautionary Tale of Etanercept Use in Patients With Toxic Epidermal Necrolysis

Faris, Janie; Wilson, Jordan; Dolman, Heather; Isaacson, Andrew; Baylor, Alfred E.; Tyburski, James G.; White, Michael

doi:10.1093/jbcr/iraa194

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…[ 35 ] Italy Case report TEN 1 Etanercept Corticosteroids After Faris et al. [ 36 ] USA Case report TEN 3 Etanercept Corticosteroids After Fischer et al. [ 37 ] Germany Case report TEN 1 Infliximab – – Frederiks et al.…”

Section: Resultsmentioning

confidence: 99%

Biologic TNF-α Inhibitors for Stevens–Johnson Syndrome, Toxic Epidermal Necrolysis, and TEN-SJS Overlap: A Study-Level and Patient-Level Meta-Analysis

Cao

Zhang

Xing

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality and not clearly established treatment protocol. This meta-analysis aimed to evaluate the efficacy and safety of three biologic TNF-α inhibitors (infliximab, etanercept, adalimumab) in the treatment of SJS, SJS-TEN overlap, and TEN. Methods Electronic databases were searched for original studies containing human participants diagnosed with SJS/TEN and treated with biologic TNF-α inhibitors. Individual patient data were collected and summarized to provide a comprehensive overview on therapeutic efficacy of different biologic TNF-α inhibitors for SJS, SJS-TEN overlap, and TEN, respectively. Meta-analyses on aggregated study data were conducted using random-effects model. Results Overall, 55 studies with 125 sets of individual patient data were included. Infliximab was used to treat 3 patients with SJS-TEN overlap and 28 patients with TEN, and the actual mortality rate was 33.3% and 17%, respectively. Etanercept was administered to 17 patients with SJS, 9 patients with SJS-TEN overlap, and 64 patients with TEN, and mortality rate was reported to be 0%, 0%, and 12.5%, respectively. For participants with TEN, no significant difference was found in time of reepithelialization, hospitalization time, and mortality rate comparing etanercept with infliximab. More sequelae were reported in patients receiving infliximab than in patients treated with etanercept (39.3% versus 6.4%). Adalimumab was administered to four patients with TEN, and mortality rate was 25%. Meta-analyses on aggregated study data revealed significantly shortened hospitalization time in etanercept compared with non-etanercept groups [weighted mean differences (WMD) −5.30; 95% confidence interval (CI) −8.65 to −1.96]. Etanercept was associated with a survival benefit for patients when compared with non-etanercept treatment, however, the analysis was not statistically significant (odds ratio 0.55; 95% CI 0.23–1.33). Conclusions On the basis of the current findings, etanercept is currently the most promising biologic therapy for SJS/TEN. Further evaluation in prospective studies is required to confirm its efficacy and safety. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-023-00928-w.

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Section: Resultsmentioning

confidence: 99%

Biologic TNF-α Inhibitors for Stevens–Johnson Syndrome, Toxic Epidermal Necrolysis, and TEN-SJS Overlap: A Study-Level and Patient-Level Meta-Analysis

Cao

Zhang

Xing

et al. 2023

Dermatol Ther (Heidelb)

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“…Cyclosporine and steroid are potent immunosuppressive and immunomodulatory drugs that, if combined with a TNF-α inhibitor, can cause over immunosuppression that can lead to bacteremia and sepsis. 10 Our systematic review found promising effects of etanercept and infliximab as therapy for SJS/TEN that help hasten skin healing, reduce time to re-epithelization, reduce mortality and shorten the length of stay with minimal complications and side effects. Our finding is similar to other systematic reviews such as Zhang et al and Sachdeva et al, which found an overall positive effect of TNF-α inhibitors with minimal complications and side effects.…”

Section: Tnf-α Inhibitors Usage In Sjs/ten Managementmentioning

confidence: 86%

“…Several studies also stated that TNF-α inhibitors are an effective treatment for SJS/TEN. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] In this systematic review, we will discuss the role of TNF-α inhibitors in SJS/TEN management.…”

Section: Study Characteristicsmentioning

confidence: 99%

The role of tumor necrosis factor-alpha (TNF-α) inhibitor in steven johnson syndrome/toxic epidermal necrolysis (SJS/TEN) management: a systematic review

Kurnia

2022

Intisari Sains Medis

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Background. Steven Johnson Syndrome and Toxic Epidermal Necrolysis are dermatologic emergencies with high mortality rates characterized by extensive skin involvement. TNF-α has a role in inducing the production of granulysin that enhances keratinocyte cell death. Thus, the use of TNF-α inhibitors such as etanercept and infliximab is promising to halt the disease progression. This systematic review aims to evaluate the efficacy of TNF-α inhibitor in SJS/TEN management. Method. A systematic review using an online database was conducted based on PRISMA guidelines. Inclusion criteria were studied about the role of TNF-α inhibitor in SJS/TEN management. The exclusion criteria were a letter to the editor, commentary report, review, meta-analysis, study not used humans as a study subject, not available in full text and not in English or Bahasa Indonesia. Result. Fourteen studies are included in this systematic review consisting of ten case reports, three cohort retrospective studies, and one randomized controlled trial. TNF-α inhibitors such as etanercept and infliximab are beneficial for SJS/TEN management because they accelerate skin healing time and re-epithelization, reduce in-hospital duration and mortality rate, and minimal complications and side effects. TNF-α inhibitors should be given quickly after the disease onset, and combination with other immunosuppressive agents should be avoided to prevent the excessive immunosuppressive effect. Conclusion. TNF-α inhibitors such as etanercept and infliximab promise therapy to halt SJS/TEN progression.

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“…within 7 days of symptom onset (skin blistering/sloughing, eye involvement, mucosal involvement). Of note, a 2021 case series from the USA reported the deaths of 3 patients with TEN who were treated with etanercept 20 . Based on their experience, the authors have proposed strict criteria for the use of Etanercept, including administration within 5 days of symptom onset (skin sloughing, eye involvement and mucosal involvement).…”

Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis in adult patients: Experience from the West Australian Collaboration

et al. 2022

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A Cautionary Tale of Etanercept Use in Patients With Toxic Epidermal Necrolysis

Cited by 4 publications

References 9 publications

Biologic TNF-α Inhibitors for Stevens–Johnson Syndrome, Toxic Epidermal Necrolysis, and TEN-SJS Overlap: A Study-Level and Patient-Level Meta-Analysis

Biologic TNF-α Inhibitors for Stevens–Johnson Syndrome, Toxic Epidermal Necrolysis, and TEN-SJS Overlap: A Study-Level and Patient-Level Meta-Analysis

The role of tumor necrosis factor-alpha (TNF-α) inhibitor in steven johnson syndrome/toxic epidermal necrolysis (SJS/TEN) management: a systematic review

Toxic epidermal necrolysis in adult patients: Experience from the West Australian Collaboration

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