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Treatment of Epidermal Necrolysis with High-Dose Intravenous Immunoglobulins (IVIg)

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Abstract

High-dose human intravenous immunoglobulins (IVIg) have now been used as a treatment for epidermal necrolysis for several years.

We have reviewed all series involving more than nine patients treated with high-dose IVIg for toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS) published in indexed journals. Nine series included a total of 156 patients; among the 156 reported cases, 32 patients died (20.5%). When the analysis was restricted to the five series that included some comparison with expected deaths, the mortality rate observed in patients treated with IVIg was 27% versus an expected rate of 30%. Because of high diversity in study designs and dosages of IVIg used, and because several series included duplicate cases, it was not possible to make more detailed statistical analyses, including individual prognostic factors and IVIg dosages.

In the absence of randomised controlled trials, this review does not provide a definite conclusion on the usefulness of IVIg in SJS or TEN; however, the analysis of published data does not suggest a dramatic efficacy.

We conclude that, in the absence of further studies, IVIg cannot yet be considered the standard of care for SJS or TEN.

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Acknowledgements

Jean-Claude Roujeau has received research grants from several drug companies for conducting research on severe cutaneous drug reactions. He was also a consultant for LFB, a laboratory marketing immunoglobulins for intravenous administration in France. Dr Faye has no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Dermatology, Hôpital Henri Mondor, Université Paris XII, Créteil, France

    Ousmane Faye &  Jean-Claude Roujeau

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  1. Ousmane Faye
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  2. Jean-Claude Roujeau
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Correspondence to Jean-Claude Roujeau.

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Faye, O., Roujeau, JC. Treatment of Epidermal Necrolysis with High-Dose Intravenous Immunoglobulins (IVIg). Drugs 65, 2085–2090 (2005). https://doi.org/10.2165/00003495-200565150-00002

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