Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine

doi:10.1016/j.jaad.2014.07.016

Journal of the American Academy of Dermatology

Volume 71, Issue 5, November 2014, Pages 941-947

https://doi.org/10.1016/j.jaad.2014.07.016 Get rights and content

Background

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous reactions, typically to medications, that are associated with a high patient mortality. Controversy exists over which systemic treatments decrease mortality associated with SJS/TEN.

Objective

In this study we sought to determine whether intravenous immunoglobulin (IVIg) or cyclosporine use for SJS/TEN results in better patient outcomes.

Methods

We undertook a retrospective chart review of 71 patients admitted between 2001 and 2011 for SJS/TEN at a tertiary care center of which 64 cases were included in the data analysis. Predicted severity-of-illness score for TEN mortality was compared with actual mortality for patients treated with either cyclosporine or IVIg.

Results

Our cohort demonstrated a relative mortality benefit to the use of cyclosporine in the treatment of SJS/TEN with a standardized mortality ratio of 0.43, over the use of IVIg with a standardized mortality ratio of 1.43.

Limitations

This is single-center retrospective study.

Conclusions

The use of cyclosporine over IVIg may offer a greater mortality benefit in the treatment of SJS/TEN.

Section snippets

Methods

The procedures and protocols of this study were reviewed and approved by the Clinical Research Ethics Board of the University of British Columbia. Using the International Classification of Diseases Version 9 codes for SJS/TEN, we were able to identify 62 patients admitted from January 2001 to December 2011 to Vancouver General Hospital, British Columbia, Canada, for SJS/TEN. Vancouver General Hospital serves as a referral center for the majority of SJS/TEN cases in the province as it has a

Results

We identified 71 patients admitted with a possible diagnosis of SJS/TEN between January 2001 and December 2011 (Fig 1). After chart review, 7 patients were excluded from further evaluation because of an alternate diagnosis. The 64 remaining patient charts were classified according to the systemic treatment received, either IVIg or cyclosporine or supportive measures only. It should be noted that none of the patients received glucocorticoids after evaluation by the dermatology service, however a

Discussion

The systemic treatment of SJS/TEN remains controversial. To date, much of the information regarding IVIg and cyclosporine use has come from case reports, case series, or small open prospective trials. In this retrospective study of IVIg versus cyclosporine, we show a mortality benefit to cyclosporine use and possible increased mortality with IVIg use.

One of the major points of contention between studies examining IVIg has been the discrepancy between low-dose IVIg (0.2-0.5 g/kg) and high-dose

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: Conflicts of interest: None declared.

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Original articleRetrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine

Background

Objective

Methods

Results

Limitations

Conclusions

Section snippets

Methods

Results

Discussion

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Invest Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Burns

Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme

Arch Dermatol

SCORTEN: a severity-of-illness score for toxic epidermal necrolysis

J Invest Dermatol

SCORTEN accurately predicts mortality among toxic epidermal necrolysis patients treated in a burn center

J Burn Care Res

SCORTEN and impaired renal function related to mortality of toxic epidermal necrolysis syndrome patients in the Asian population

J Eur Acad Dermatol Venereol

Toxic epidermal necrolysis: performance of SCORTEN and the score-based comparison of the efficacy of corticosteroid therapy and intravenous immunoglobulin combined therapy in China

J Burn Care Res

Analysis of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis using SCORTEN: the University of Miami experience

Arch Dermatol

Open trial of cyclosporin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis

Br J Dermatol

Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: a prospective comparative open-labelled study of 36 cases

Indian J Dermatol Venereol Leprol

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of treatment options

Dermatol Ther

Original article
Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine