Human leucocyte antigen association of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis with severe ocular complications in Han Chinese

Chung, Wen Hung; Hsueh, Yi‐Jen; Chen, Shin‐Yi; Tokunaga, Katsushi; Kinoshita, Shigeru; David, H. K.; Ueta, Mayumi

doi:10.1136/bjophthalmol-2020-317105

Cited by 27 publications

(29 citation statements)

References 52 publications

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“…Recently, cold medicine (antipyretic or analgesic but not antibiotics a patient takes when catching cold) was thought to be the most common drug that induces SOCs in chronic SJS/TEN ( 25 – 29 ). We also had similar observations in our recent study based on patients from outpatient clinics, and identified HLA B * 0207 to be associated with cold medicine-induced SJS/TEN with SOCs ( 30 ). In this study, NSAID and cold medicine were found to be the most common causative medications that were associated with chronic SOCs.…”

Section: Discussionsupporting

confidence: 84%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

et al. 2021

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Purpose: Over the last decade, there has been tremendous progress in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To understand whether this has resulted in better ophthalmic outcomes, we aimed to study the incidence of severe ocular complications (SOCs) in the acute and chronic stage among SJS/TEN patients, major causative medications, and therapeutic effect of medical and surgical treatment.Methods: Using electronic medical records review of patients of Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020, 119 patients (236 eyes) received ophthalmic consultation during the acute stage and were retrospectively studied. Sotozono's grading score systems for acute and chronic SJS/TEN were employed for accessing correlation between acute and chronic presentations, the therapeutic effect of systemic etanercept treatment, and outcome of early amniotic membrane transplantation (AMT) performed in patients with severe acute SOCs.Results: There were 46 male and 73 female patients with a mean age of 45.6 ± 22.7 years old (2–90 years), and follow-up time of 408.3 ± 351.0 (116–1,336) days. The numbers of patients with SJS, overlap syndrome, and TEN were 87, 9, and 23, respectively. In total, 109 eyes (55 patients) had acute SOCs, which comprised 46.2% of patients who underwent ophthalmic examination. Antiepileptics were the most common category of culprit drugs causing SOCs in the acute stage. At the end of follow-up, there were 14 eyes (9 patients) with chronic SOCs (5.9%), and non-steroidal anti-inflammatory drugs and cold medicine were the most common causative medications that were associated with severe chronic sequela. The correlation between Sotozono's acute and chronic grading score showed a positive relationship [Spearman's rank correlation coefficient (r) = 0.52, p < 0.001]. The average chronic grading scores in patients receiving systemic corticosteroid combined with etanercept treatment were significantly lower than those receiving corticosteroid only, Finally, the average chronic grading scores in patients receiving AMT <7 days after onset were significantly lower than those performed beyond 7 days.Conclusion: Our study implies that acute manifestation can be an indicator for chronic sequelae. Additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.

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Section: Discussionsupporting

confidence: 84%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

et al. 2021

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“…Although the carrier- and gene frequency of HLA-A * 02:06 in Japanese patients with CM-SJS/TEN with SOCs was significantly higher than in the control group, the frequency of HLA-A * 02:07 was similar in both groups ( 2 ). We found that the expression of HLA-A * 02:07 but not of HLA-A * 02:06 was associated with CM-SJS/TEN with SOC in the Han Chinese patients ( 26 ).…”

Section: Hla Types Associated With Sjs/ten With Socmentioning

confidence: 76%

“…Together with our Taiwanese collaborators we performed HLA analysis of SJS/TEN with SOC in the Han Chinese and found that HLA-A * 02:07 (26 patients, 98 controls; OR =3.2, p = 0.049) was associated with their development of the disease. Our focus on CM-SJS/TEN with SOC revealed that HLA-A * 02:07 (13 patients, 98 controls; OR = 5.6, p = 0.016) was strongly associated with the development of SOC among Han Chinese CM-SJS/TEN patients (26). Single amino acid substitutions in major histocompatibility complex (MHC) class I molecules were found to play a role in distinct peptide repertoires.…”

Section: Taiwanmentioning

confidence: 97%

“…Our Taiwanese collaborators found that the main causative drugs in 26 Han Chinese with SJS/TEN with SOC were cold medicines; in 13 of 26 patients with SOC, cold medicines were the causative drugs, in none of 7 patients without SOC they identified cold medications as causative ( 26 ). Their findings echoed earlier studies that implicated cold medicines in the development of SOC in 80% of Japanese SJS/TEN patients ( 2 , 35 ), 53% of Brazilian patients ( 24 ), and 69% of Thai patients ( 25 ).…”

Section: Hla Types Associated With Sjs/ten With Socmentioning

confidence: 99%

“…These included multi-ingredient cold medications and non-steroidal anti-inflammatory drugs (NSAIDs) ( 2 , 4 , 6 , 8 , 23 ). Our Brazilian collaborators found that 53% of their SJS/TEN with SOC patients had taken cold medicines ( 24 ) as had 69% of Thai patients with SJS/TEN with SOC ( 25 ), and 50% of Taiwanese patients ( 26 ). Our Korean collaborators suspected that NSAIDs and cold medicines were associated with SOC in their SJS/TEN patients ( 27 ).…”

Section: Introductionmentioning

confidence: 99%

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Findings by an International Collaboration on SJS/TEN With Severe Ocular Complications

Ueta

2021

Front. Med.

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Stevens-Johnson Syndrome (SJS) is an acute inflammatory vesiculobullous reaction of the skin and mucosa, e.g., the ocular surface, oral cavity, and genitals. In patients with extensive skin detachment and a poor prognosis, the condition is called toxic epidermal necrolysis (TEN). Not all, but some patients with SJS/TEN manifest severe ocular lesions. Approximately 50% of SJS/TEN patients diagnosed by dermatologists and in burn units suffer from severe ocular complications (SOC) such as severe conjunctivitis with pseudomembrane and ocular surface epithelial defects in the acute stage. In the chronic stage, this results in sequelae such as severe dry eye and visual disturbance. Before 2005, our group of Japanese scientists started focusing on ophthalmic SJS/TEN with SOC. We found that cold medicines were the main causative drugs of SJS/TEN with SOC and that in Japanese patients, HLA-A*02:06 and HLA-B*44:03 were significantly associated with cold medicine-related SJS/TEN with SOC (CM-SJS/TEN with SOC). We expanded our studies and joined scientists from Korea, Brazil, India, Taiwan, Thailand, and the United Kingdom in an international collaboration to detect the genetic predisposition for SJS/TEN with SOC. This collaboration suggested that in Japanese patients, cold medicines, including NSAIDs, were the main causative drugs, and that HLA-A*02:06 was implicated in Japanese and Korean patients and HLA-B*44:03 in Japanese-, Indian-, and European ancestry Brazilian patients. Our joint findings reveal that there are ethnic differences in the HLA types associated with SJS/TEN with SOC.

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Patients with obstructive sleep apnea are at great risk of flavor disorders: a 15-year population-based cohort study

Huang

Hung

et al. 2022

Clin Oral Invest

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Human leucocyte antigen association of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis with severe ocular complications in Han Chinese

Cited by 27 publications

References 52 publications

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

Findings by an International Collaboration on SJS/TEN With Severe Ocular Complications

Patients with obstructive sleep apnea are at great risk of flavor disorders: a 15-year population-based cohort study

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