Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis

Egan, Catherine; Petersen, MJ; Meyer, LJ; Grant, WJ; Morris, SE; Saffle, JR; Zone, JJ

doi:10.1016/s0923-1811(98)83254-4

Cited by 33 publications

(42 citation statements)

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“…16 Even though some uncertainty persists on effector mechanisms of TEN, the resemblance to graft rejection provided a rationale for using immunomodulating agents. These included corticosteroids, 16 plasmapheresis, 17,18 cyclophosphamide, 19 thalidomide 13 and high-dose intravenous immunoglobulins (IVIG). 11,20 None has clearly proven its efficacy in prevention of mortality and ⁄or progression of skin detachment.…”

Section: Discussionmentioning

confidence: 99%

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

Valeyrie‐Allanore¹,

Wolkenstein²,

Brochard³

et al. 2010

British Journal of Dermatology

237

139

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Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)are acute mucocutaneous reactions associated with poor prognosis. The treatment is mainly symptomatic, based on supportive care. Until now, several curative treatments have been proposed without evidence of effectiveness.Objectives To evaluate the effect of ciclosporin on SJS and TEN after a short series had suggested a benefit.Methods We conducted an open, phase II trial to determine the safety and possible benefit of ciclosporin. Among the 45 consecutive patients admitted for SJS /TEN from March 2005 to September 2007, 29 fulfilled inclusion criteria. Ciclosporin was administered orally (3 mg kg)1 daily for 10 days) and tapered over a month. Clinical and biological evaluations were performed sequentially. Predicted death rate was estimated with a validated prognostic score (SCORTEN).Results Twenty-nine patients were included at a mean +/- SD of 2.8 +/- 1.8 days after onset. The final diagnosis was SJS (n = 10), SJS ⁄TEN overlap (n = 12) and TEN(n = 7). One month of treatment was completed in 26. Ciclosporin was stopped after more than 10 days in three cases for side-effects including posterior leucoencephalopathy (n = 1), neutropenia (n = 1) and nosocomial pneumopathy(n = 1). Ciclosporin dosage was tapered earlier than scheduled in two cases for alteration in renal function. The prognostic score predicted 2.75 deaths; none occurred (P = 0.1). Mean epidermal detachment remained stable in 18 of 29 cases (62%). The mean ± SD hospital stay was 16.2 +/- 9.1 days.Conclusions Both the death rate and the progression of detachment seemed lower than expected, suggesting a possible usefulness of ciclosporin in SJS and TEN that needs to be confirmed.

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Section: Discussionmentioning

confidence: 99%

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

Valeyrie‐Allanore¹,

Wolkenstein²,

Brochard³

et al. 2010

British Journal of Dermatology

237

139

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“…[8][9][10][11] Many therapeutic modalities, including systemic steroids, plasmapheresis and immunosuppressant drugs, have been utilized. 2,[12][13][14] Despite many reports describing the efficacy of these modalities, none of them has been established as the standard in SJS/TEN care. Because naturally occurring Fasblocking antibodies in IVIG are thought to inhibit Fas-mediated keratinocyte apoptosis, 10 i.v.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of additional i.v. immunoglobulin to steroid therapy in Stevens–Johnson syndrome and toxic epidermal necrolysis

Aihara

Kano

Fujita

et al. 2015

The Journal of Dermatology

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and life-threatening cutaneous adverse drug reactions. While there is no established therapy for SJS/TEN, systemic corticosteroids, plasma exchange and i.v. immunoglobulin (IVIG) have been used as treatment. The efficacy of IVIG is still controversial because total doses of IVIG used vary greatly from one study to another. The aim of this study was to evaluate the efficacy of IVIG, administrated for 5 days consecutively, in an open-label, multicenter, single-arm study in patients with SJS or TEN. IVIG (400 mg/kg per day) administrated for 5 days consecutively was performed as an additional therapy to systemic steroids in adult patients with SJS or TEN. Efficacy on day 7 of IVIG was evaluated. Parameters to assess clinical outcome were enanthema including ophthalmic and oral lesions, cutaneous lesions and general condition. These parameters were scored and recorded before and after IVIG. We enrolled five patients with SJS and three patients with TEN who did not respond sufficiently to systemic steroids before IVIG administration. All of the patients survived and the efficacy on day 7 of the IVIG was 87.5% (7/8 patients). Prompt amelioration was observed in skin lesions and enanthema in the patients in whom IVIG therapy was effective. Serious side-effects from the use of IVIG were not observed. IVIG (400 mg/kg per day) administrated for 5 days consecutively seems to be effective in patients with SJS or TEN. IVIG administrated together with steroids should be considered as a treatment modality for patients with refractory SJS/TEN. Further studies are needed to define the therapeutic efficacy of IVIG.

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“…11 In single cases, cyclosporine, cyclophosphamide and plasmapheresis have all been successfully used but there has not yet been any serious control study. [12][13][14] Another preliminary result, without controls and requiring confirmation, was obtained in 10 patients treated with i.v. human immunoglobulins.…”

Section: Discussionmentioning

confidence: 93%