Intravenous Immunoglobulin for the Treatment of Toxic Epidermal Necrolysis

Trent, Jennifer T.; Kerdel, Francisco A.

doi:10.1001/archderm.139.8.1081-a

Cited by 10 publications

(2 citation statements)

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“…They observed an increase in mortality compared to that predicted (32% vs. 24%, respectively), the results being worse in patients with renal insufficiency 42 . It has been suggested that higher doses of IVIG may be necessary to obtain a survival benefit, 38,43,44 and so in this study patients were separated depending on treatment dose (≥ or <3 g/kg IVIG, see Table ), but no differences in the efficacy were observed (Figure ) (for more information, see point 3 in the ) 45‐49 …”

Section: Discussionmentioning

confidence: 60%

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

Torres‐Navarro

Briz‐Redón

Botella‐Estrada

2020

Acad Dermatol Venereol

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BackgroundThe SCORTEN score is a specific predictor of mortality for patients with Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). There is little evidence in support of the common immunomodulating therapies for SJS/TEN.ObjectivesTo systematically assess the effectiveness of several therapies for SJS/TEN through the SCORTEN score.MethodsDatabases were searched for original studies on the use of SCORTEN. Six meta‐analyses were carried out on patients with SJS/TEN who received supportive care only or in combination with immunomodulating drugs: corticosteroids, cyclosporine, etanercept, immunoglobulins or a combination of corticosteroids with immunoglobulins. A multivariate meta‐regression and a network meta‐analysis were also performed.ResultsOf 3893 studies identified, fifty‐two involving 2466 patients with SJS/TEN were preselected. Data from thirty‐eight of these studies (1827 patients) were finally pooled, and results [log(SMR)] from meta‐analyses were as follows: −0.13 (95% CI, −0.42,0.16) for corticosteroids, −0.39 (95% CI, −0.87,0.09) for immunoglobulins, 0.13 (95% CI, −0.15,0.40) for supportive treatment, −0.88 (95% CI, −1.47, −0.29) for cyclosporine, −0.95 (95% CI, −1.82, −0.07) for etanercept and − 0.56 (95% CI, −0.94, −0.19) for immunoglobulins plus corticosteroids. The meta‐regression analysis confirmed that cyclosporine and immunoglobulins plus corticosteroids were associated with less deaths than predicted by SCORTEN. In the network meta‐analysis, no treatment achieved a significant reduction in the SMR.LimitationsHeterogeneity and quality of the included studies.ConclusionsSome treatments for SJS/TEN show a better performance, but there is not sufficient evidence to recommend its widespread use in all patients.

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Section: Discussionmentioning

confidence: 60%

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

Torres‐Navarro

Briz‐Redón

Botella‐Estrada

2020

Acad Dermatol Venereol

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“…Using the standardized mortality ratio, patients with TEN treated with IVIG were 84.5% less likely to die. [7][8][9] The findings of these research efforts were presented at the annual meetings of the Society of Investigative Dermatology and the American Academy of Dermatology and published in several papers in the Archives of Dermatology and the Journal of the American Academy of Dermatology. She received the University of Miami Celia and Samuel Resnik Award for Dermatology Resident Research for these findings.…”

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confidence: 99%