Comparison of cyclosporine and systemic corticosteroid for treating drug reaction with eosinophilia and systemic symptoms syndrome: A retrospective 20‐year single‐centre study in South Korea

Abstract

Background/Objectives: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening hypersensitive disorder.Cyclosporine has been indicated for adverse cutaneous drug eruptions. However, studies evaluating its clinical effectiveness in DRESS syndrome have been rare.This study aimed to evaluate the clinical efficacy of cyclosporine in DRESS syndrome compared to that of systemic corticosteroids. Methods:In the cyclosporine group, oral cyclosporine was administered twice a day for a total of 2-3 mg/kg/day for 1 week, and subsequently reduced to 1-1.5 mg/kg/day for extended treatment. In the corticosteroid group, intravenous or oral methylprednisolone was administered at 1-1.5 mg/kg/day for 1 week, with variable tapering plans. Laboratory changes before and after treatment, hospitalized days, treatment periods, and time to normalization from clinical manifestations in each group were statistically evaluated. Adverse effects of these regimens were observed during the entire treatment period.Results: Eighty patients were enrolled in this retrospective study. The cyclosporine and corticosteroid group had 27 and 53 patients, respectively. Total leucocyte and eosinophil counts, liver enzymes, and C-reactive proteins were significantly decreased after treatment in both groups. There were no statistically significant differences observed in hospitalized days, treatment period, and time to normalization from clinical manifestations between the two groups. The corticosteroid group experienced relatively more adverse effects than the cyclosporine group. Conclusions:Cyclosporine was discovered to be clinically effective in DRESS syndrome and this study suggests that cyclosporine could be a feasible primary therapeutic option for DRESS syndrome.

Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms

“…Evidence is based only on small retrospective case series. In the latter, IVIGs are either combined with systemic corticosteroid therapy in steroid-refractory cases or with cyclosporine as a first-line regimen . For IVIGs, toxic effects have been reported when these were used as single agents without corticosteroids in DRESS .…”

Cyclosporine in the Treatment of Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome: Retrospective Cohort Study

“…Corticosteroids, as opposed to cyclosporine, are the standard of care in the treatment of DRESS syndrome. Therefore, this literature on cyclosporine in the treatment of DRESS syndrome has been limited to primarily small case reports, 1 case-control study with 5 patients treated with cyclosporine compared to 21 patients treated with corticosteroids [4], and 1 retrospective study with 27 patients treated with cyclosporine compared to 53 patients treated with corticosteroids [12]. The previous cases are summarized in the Multimedia Appendix 1 [2][3][4][5][6][7][8][9][10][11][13][14][15][16].…”

“…Data from the retrospective study are not included in the summary, as the data were aggregated and could not be separated into individual cases. The vast majority of these previous studies have suggested that cyclosporine is effective and may lead to rapid clinical resolution of DRESS syndrome [2][3][4][5][6][7][8][9][10][11][12]16]. In the case-control study, the patients treated with cyclosporine were found to have a shorter time to clinical resolution than those treated with corticosteroids [4].…”

“…Additionally, corticosteroid therapy may be contraindicated, induce adverse events (such as hyperglycemia and hypertension), and increase the risk of viral reactivation. To the best of our knowledge, there are only 54 previously reported cases of cyclosporine use in the treatment of DRESS syndrome [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Half of these previously reported cases (27 of 54) are reported in a retrospective study comparing cyclosporine to corticosteroid use in the treatment of DRESS syndrome, which found that there was no significant difference in time to resolution of DRESS syndrome between the 2 groups.…”

“…Half of these previously reported cases (27 of 54) are reported in a retrospective study comparing cyclosporine to corticosteroid use in the treatment of DRESS syndrome, which found that there was no significant difference in time to resolution of DRESS syndrome between the 2 groups. However, there were more adverse events in the corticosteroid group compared to the cyclosporine group [12]. Of the remaining, 27 cases, 23 cases have demonstrated cyclosporine to be an effective alternative therapy to corticosteroids [2][3][4][5][6][7][8][9][10][11].…”