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Treating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis - 11/01/21

Doi : 10.1016/j.jaad.2020.08.122 
Tsung-Yu Tsai, MD a, b, I-Hsin Huang, MD c, Yuan-Chen Chao, MD d, Hua Li, MA e, Tyng-Shiuan Hsieh, MD d, Hsiao-Han Wang, MD a, b, f, Yu-Ting Huang, MA g, Chun-Yuan Chen, PhD b, h, Ying-Chih Cheng, MD e, i, Po-Hsiu Kuo, PhD e, Yu-Chen Huang, MD a, b, f, , Yu-Kang Tu, DDS, PhD b, e, j,
a Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 
b Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 
c Department of Education, Taipei Medical University Hospital, Taipei, Taiwan 
d Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan 
e Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan 
f Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 
g Wan Fang Hospital Library, Taipei Medical University, Taipei, Taiwan 
h Biostatistics Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 
i Department of Psychiatry, Taoyuan Psychiatric Centre, Ministry of Health and Welfare, Taoyuan City, Taiwan 
j Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan 

Correspondence to: Yu-Kang Tu, DDS, PhD, Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, 17 Xu-Zhou Road, Taipei City, Taiwan.Institute of Epidemiology and Preventive MedicineNational Taiwan University College of Public Health17 Xu-Zhou RoadTaipei CityTaiwanYu-Chen Huang, MD, Department of Dermatology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xinglong Rd, Wenshan District, Taipei City, Taiwan.Department of DermatologyWan Fang HospitalTaipei Medical UniversityNo. 111, Section 3, Xinglong Rd, Wenshan DistrictTaipei CityTaiwan

Abstract

Background

Various systemic immunomodulating therapies have been used to treat toxic epidermal necrolysis (TEN), but their efficacy remains unclear.

Objective

To perform a systematic review and network meta-analysis (NMA) evaluating the effects of systemic immunomodulating therapies on mortality for Stevens-Johnson syndrome (SJS)/TEN overlap and TEN.

Methods

A literature search was performed in online databases (from inception to October 31, 2019). Outcomes were mortality rates and Score of Toxic Epidermal Necrolysis (SCORTEN)–based standardized mortality ratio (SMR). A frequentist random-effects model was adopted.

Results

Sixty-seven studies involving 2079 patients were included. An NMA of 10 treatments showed that none was superior to supportive care in reducing mortality rates and that thalidomide was associated with a significantly higher mortality rate (odds ratio, 11.67; 95% confidence interval [CI], 1.42-95.96). For SMR, an NMA of 11 treatment arms showed that corticosteroids and intravenous immunoglobulin combination therapy was the only treatment with significant survival benefits (SMR, 0.53; 95% CI, 0.31-0.93).

Limitations

Heterogeneity and a paucity of eligible randomized controlled trials.

Conclusions

Combination therapy with corticosteroids and IVIg may reduce mortality risks in patients with SJS/TEN overlap and TEN. Cyclosporine and etanercept are promising therapies, but more studies are required to provide clearer evidence.

Le texte complet de cet article est disponible en PDF.

Key words : corticosteroids, intravenous immunoglobulin, network meta-analysis, SCORTEN, Stevens-Johnson syndrome, toxic epidermal necrolysis

Abbreviations used : BSA, CI, ETN, IPD, IVIg, MR, NAC, NMA, RCT, SCORTEN, SIT, SJS, SMR, SUCRA, TBSA, TEN


Plan


 Drs Tu and Huang contributed equally to this article.
 Funding sources: None.
 Conflicts of interest: None disclosed.
 IRB approval status: Not applicable.
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 84 - N° 2

P. 390-397 - février 2021 Retour au numéro
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