Treating toxic epidermal necrolysis with systemic immunomodulating therapies: A systematic review and network meta-analysis - 11/01/21
, Yu-Kang Tu, DDS, PhD b, e, j, ⁎ 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.
Il testo completo di questo articolo è disponibile in 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
Mappa
| Drs Tu and Huang contributed equally to this article. |
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| Funding sources: None. |
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| Conflicts of interest: None disclosed. |
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| IRB approval status: Not applicable. |
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| Reprints not available from the authors. |
Vol 84 - N° 2
P. 390-397 - febbraio 2021 Ritorno al numero
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