Severe cutaneous adverse drug reactions: Incidence, clinical patterns, causative drugs and modalities of treatment in Assiut University Hospital, Upper Egypt

Abou-Taleb, Doaa A E; El‐Sayed, Ahmed M.; Ghabesha, Ayad A.; Hassan, Sahar B.

doi:10.1111/dth.14176

Cited by 6 publications

(6 citation statements)

References 54 publications

(89 reference statements)

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“…The remaining 4467 studies were screened for title, abstract, and full text, and 64 potentially relevant studies were identified. Of the 64 studies that underwent data extraction, 3 studies described the same study population and were excluded from the meta-analysis. Furthermore, there were 23 studies that did not count the SJS/TEN associations at the patient level and thus were excluded.…”

Section: Resultsmentioning

confidence: 99%

“…In the end, the meta-analysis included 38 retrospective observational studies with 2917 patients from more than 20 countries . There were 16 studies from Asia (1298 patients), 14 studies from North America (932 patients), 4 studies from Europe (208 patients), 3 studies from Africa (437 patients), and 1 study from Australia (42 patients).…”

Section: Resultsmentioning

confidence: 99%

“…The pooled proportion of antibiotics associated with SJS/TEN (38 studies; 2917 patients) was 28% (95% CI, 24%-33%), with moderate certainty of evidence (Figure 2). There was no evidence of publication bias (eFigure 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

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Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

2023

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ImportanceAntibiotics are an important risk for Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), which are the most severe types of drug hypersensitivity reaction with a mortality rate up to 50%. To our knowledge, no global systematic review has described antibiotic-associated SJS/TEN.ObjectiveTo evaluate the prevalence of antibiotics associated with SJS/TEN worldwide.Data SourcesThe MEDLINE and Embase databases were searched for experimental and observational studies that described SJS/TEN risks since database inception to February 22, 2022.Study SelectionIncluded studies adequately described SJS/TEN origins and specified the antibiotics associated with SJS/TEN.Data Extraction and SynthesisTwo reviewers (E.Y.L. and C.K.) independently selected the studies, extracted the data, and assessed the risk of bias. A meta-analysis using a random-effects model was performed in the studies that described patient-level associations. Subgroup analyses were performed to explore the heterogeneity. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.Main Outcomes and MeasuresPrevalence of antibiotic-associated SJS/TEN was presented as pooled proportions with 95% CIs.ResultsAmong the 64 studies included in the systematic review, there were 38 studies that described patient-level associations; the meta-analysis included these 38 studies with 2917 patients to determine the prevalence of single antibiotics associated with SJS/TEN. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24%-33%), with moderate certainty of evidence. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22%-44%) of cases, followed by penicillins (22%; 95% CI, 17%-28%), cephalosporins (11%; 95% CI, 6%-17%), fluoroquinolones (4%; 95% CI, 1%-7%), and macrolides (2%; 95% CI, 1%-5%). There was a statistically significant heterogeneity in the meta-analysis, which could be partially explained in the subgroup analysis by continents. The overall risk of bias was low using the Joanna Briggs Institute checklist for case series.Conclusion and RelevanceIn this systematic review and meta-analysis of all case series, antibiotics were associated with more than one-quarter of SJS/TEN cases described worldwide, and sulfonamide antibiotics remained the most important association. These findings highlight the importance of antibiotic stewardship, clinician education and awareness, and weighing the risk-benefit assessment of antibiotic choice and duration.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

2023

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“…The usage of corticosteroids is concerning for increasing the risk of protein catabolism and bacterial infection/sepsis and slowing the rate of epithelialization ( McCullough et al, 2017 ; Tocco-Tussardi et al, 2017 ). Early and recent observational studies suggested significantly higher rates of infection, complications, and increased mortality ( Abou-Taleb et al, 2020 ; Halebian et al, 1986 ; Kelemen et al, 1995 ; Schneck et al, 2008 ); an updated mortality analysis of the RegiSCAR study and a systemic review of case series based on SCORTEN algorithm failed to confirm a survival benefit for systemic corticosteroid-treated patients ( Roujeau and Bastuji-Garin, 2011 ; Sekula et al, 2013 ). However, there still have been many research ( Kim et al, 2012 ; Liu et al, 2016 ; Schneck et al, 2008 ) and systemic reviews ( Zimmermann et al, 2017 ) supporting that systemic corticosteroids were life-saving and could reduce ocular complications.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin Combined With Corticosteroids for the Treatment of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Propensity-Matched Retrospective Study in China

Lü

Shou

et al. 2022

Front. Pharmacol.

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Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening severe adverse drug reactions. The use of corticosteroids and intravenous immunoglobulin (IVIg) in SJS/TEN remains controversial.Methods: In this single-center, observational, propensity-matched, retrospective study, we collected a total of 224 patients with SJS/TEN who were hospitalized in our department from 2008 to 2019; according to treatment with IVIg combined with corticosteroids or with corticosteroids alone, patients were divided into combination therapeutic group (163 patients) and monotherapeutic group (61 patients). Patients from the two groups were matched by their propensity score in blocks of 2:1. Comparisons of the clinical characteristics and prognoses between propensity-matched SJS/TEN patients treated with IVIg combined with corticosteroids and corticosteroids alone were made.Results: After our propensity matching, a total of 145 patients were yielded, including 93 patients treated with IVIg and 52 patients not treated with IVIg. All of the 23 variables reflected good matching between patients treated with/without IVIg, and no significant difference was observed. Although there was no significant difference between the totally predicted and actual mortality in both of our groups, the actual mortality was lower than it was predicted in patients treated with IVIg [p > 0.250, the standardized mortality ratio (SMR) was 0.38, 95% CI 0.00–0.91] and patients treated without IVIg (p = 1.000, the SMR was 0.75, 95% CI 0.00–1.76). IVIg tended toward reducing the time to arrest of progression by 1.56 days (p = 0.000) and the length of hospital stay by 3.37 days (p = 0.000). The mortality rate was 45% lower for patients treated with IVIg combined with corticosteroids than those only treated with corticosteroid therapy, although it was not statistically significant (p = 0.555). The incidence of skin infections was significantly lower in the combined therapy group (p < 0.025), and the total infection rate of patients treated with combination therapy tended to decrease by 67% compared to patients treated with corticosteroids alone (p = 0.047).Conclusion: The actual mortality rate of patients treated with corticosteroids alone or IVIg combined with corticosteroids tended to be lower than those predicted by TEN-specific severity-of-illness score (SCORTEN), although there was no significance. Compared with those treated by corticosteroids alone, combination therapy was prone to bring a better prognosis for SJS/TEN patients.

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“…For example, a dose greater than or equal to 200 mg of allopurinol per day is associated with a high risk of SJS/TEN [28]. In addition to the common drugs related to SCARs [29][30][31][32] (Table 1), Chinese materia medica and new sensitizing drugs have been reported [33], such as antihypertensive drugs (cannabinol [34], hydrochlorothiazide [35]), antifungal drugs (griseofulvin [36], terbinafine [37]), and non-steroidal anti-aromatase (letrozole) [38].…”

Section: Epidemiologymentioning

confidence: 99%

Current Perspectives on Severe Drug Eruption

Zhang

Lei

et al. 2021

Clinic Rev Allerg Immunol

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Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA-and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management. Keywords Severe drug eruption • Stevens-Johnson syndrome • Toxic epidermal necrolysis • Acute generalized exanthematous pustulosis • Drug reaction with eosinophilia and systemic symptoms Abbreviations AGEP Acute generalized exanthematous pustulosis ALT Alanine aminotransferase APCs Antigen-presenting cells AST Aspartate aminotransferase CBZ Carbamazepine CCR CC-chemokine receptor COVID-19 Coronavirus disease 2019 CTL Cytotoxic T cells CXCR CXC chemokine receptor DiHS

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Severe cutaneous adverse drug reactions: Incidence, clinical patterns, causative drugs and modalities of treatment in Assiut University Hospital, Upper Egypt

Cited by 6 publications

References 54 publications

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Intravenous Immunoglobulin Combined With Corticosteroids for the Treatment of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Propensity-Matched Retrospective Study in China

Current Perspectives on Severe Drug Eruption

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