Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment

Abstract

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. Objectives To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality. Methods We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of SJS/TEN at the Ross Tilley Burn Center between the years 1999 and 2015. Results A total of 43 patients were identified with a mean age of 54 ± 19 (58, 18-85). The most common offending medications were allopurinol and carbamazepine. The overall mortality rate in our study is 21% with the most common causes of death being multiorgan failure and sepsis. The majority of our patients had oral (84%), ocular (79%), and genital (60%) involvement during hospitalization. Our data revealed that combination treatment involving oral corticosteroids with intravenous immunoglobulin (IVIG) had the highest mortality rate in our study since 55% (6/11) of patients who were treated in this manner passed away compared to 11% (2/18) of patients passing away who were treated with solely IVIG and 33% (1/3) who were treated with only supportive care. Our study also demonstrates the addition of etanercept and cyclosporine treatment in the second time period we studied: 2008-2015 versus the earlier time period of 1999-2007. None of the patients in our study who were treated with therapies including cyclosporine and/or etanercept passed away. Conclusions Our study sheds light on a possible beneficial role of cyclosporine and etanercept for the treatment of SJS and TEN and reinforces the necessity of a multidisciplinary care team for patients.

Combined use of cyclosporine in the treatment of Stevens–Johnson syndrome/toxic epidermal necrolysis

“…The disease burden of SJS/TEN is still severe nowadays. In our cohort, the total death rate is 15.2%, which is comparable to many other studies, ranging 15–50% 20–23 . Worse still, the median length of stay is 15.3 days with a median cost of more than 1000 yuan per day in hospital.…”

“…In our cohort, the total death rate is 15.2%, which is comparable to many other studies, ranging 15-50%. [20][21][22][23] Worse still, the median length of stay is 15.3 days with a median cost of more than 1000 yuan per day in hospital. This undoubtedly aggravates the time and money expenses of SJS/TEN patients.…”

Highlighting adalimumab as a treatment option for systemic treatment of toxic epidermal necrolysis: A case series from a tertiary specialised burns centre

“…TEN is a medical emergency with a mortality rate of up to 30% 3 . The benefits of prompt immunosuppressive treatment include halting the progression of TEN and limiting the extent of exfoliated skin, which would otherwise render those with TEN susceptible to sepsis and thermal imbalances, as well as arresting the systemic inflammatory process that can lead to multi‐organ failure requiring intensivist support 6 . We have shown for the first time, to our knowledge, that adalimumab has comparable efficacy and safety to other immunosuppressive agents in the treatment of TEN at our centre resulting in a shorter duration of hospitalisation.…”

A Case of Toxic Epidermal Necrolysis Caused by the Use of Trimethoprim Alone

“…The emergency management of patients with SJS or TEN requires a multidisciplinary team approach, withdrawal of the offending drug, and prompt referral to a specialist center where possible for supportive therapy, which forms the mainstay of management [1,2,9].…”