Risk factors and drugs that trigger the onset of Stevens–Johnson syndrome and toxic epidermal necrolysis: A population-based cohort study using the Shizuoka Kokuho database

Ubukata, Nanako; Nakatani, Eiji; Hashizume, Hideo; Sasaki, Hatoko

doi:10.1016/j.jdin.2022.12.002

Cited by 11 publications

(9 citation statements)

References 48 publications

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“…Nevertheless, the most important genetic risk factors for the most common systemic autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus) are attributed to human leukocyte antigen (HLA) alleles [ 19 , 20 ]. Moreover, the risk of SJS/TEN is greater in people with autoimmune diseases and diabetes mellitus [ 21 ]. In our sample, 6.3% of the patients had an autoimmune disease, and 6.3% has been diagnosed with diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment of Ophthalmic Sequelae of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Eyecare Centre in Hungary

Tóth,

Lukács,

Stachon

et al. 2024

Ophthalmol Ther

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Introduction This study analysed the causative factors and clinical characteristics of acute and chronic ocular sequelae of Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) treated at a large third-referral centre in a developed country (Hungary) over a 15-year period. Methods This was a retrospective review of patients with acute and/or chronic SJS/TEN who were managed between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University in Budapest, Hungary. For each subject, clinical data, including patient demographics, clinical history, causative agents of SJS/TEN, and conservative and surgical treatment details, were reviewed. Results Ninety-six eyes of 48 patients were included (28 female; 58.3%); the age at disease onset was 32.1 ± 22.4 years. The most common causative factors were medicines ( n = 36; 75.0%). Among these drugs, 29.2% were nonsteroidal anti-inflammatory drugs (NSAIDs) ( n = 14), 20.8% were antibiotics ( n = 10) and 14.6% were antiepileptic drugs ( n = 7). In patients with chronic SJS/TEN, the most commonly found ocular sequelae were conjunctival hyperaemia in 45 (56.3%) eyes, symblepharon in 38 (47.5%) eyes, trichiasis/distichiasis in 37 (46.3%) eyes, corneal neovascularization in 31 (38.8%) eyes and corneal scarring in 29 (36.3%) eyes. In patients with chronic SJS/TEN, the most frequently used topical conservative treatment included antibiotics in 53 (66.3%) eyes, preservative-free artificial tears in 50 (62.5%) eyes and topical corticosteroids in 42 (52.5%) eyes of 40 patients. The most frequently performed ocular surgeries for managing chronic ocular sequelae in patients with SJS/TEN were epilation for trichiasis ( n = 27; 33.8%), cataract surgery ( n = 14; 17.5%), entropion surgery ( n = 12; 15.0%), penetrating keratoplasty (PK) ( n = 11; 13.8%) and amniotic membrane transplantation ( n = 4; 5.0%). Conclusion Our results suggest that NSAIDs, antibiotics and antiepileptic drugs are the most common causative factors for SJS/TEN in Hungary. Like in other countries, in Hungary, the ocular management of patients with acute and chronic SJS/TEN is heterogeneous, and most cases do not follow modern therapeutic guidelines. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-024-00924-z.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatment of Ophthalmic Sequelae of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Eyecare Centre in Hungary

Tóth,

Lukács,

Stachon

et al. 2024

Ophthalmol Ther

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“…Located in the country's center, Shizuoka Prefecture is representative of Japan because it includes characteristics of nature, climate, industry, economy, and culture that are typical to the country. The SKDB includes information on a regional population‐based longitudinal cohort of 2 398 393 Japanese individuals (women, n = 1 303 667, 54.4%) living in Shizuoka Prefecture (population: approximately 3.6 million) 10 and has been used as a data source for several studies 11–13 . Comprehensive personally linked data were collected and all individuals were uniquely identified.…”

Section: Methodsmentioning

confidence: 99%

“…The SKDB includes information on a regional population‐based longitudinal cohort of 2 398 393 Japanese individuals (women, n = 1 303 667, 54.4%) living in Shizuoka Prefecture (population: approximately 3.6 million) 10 and has been used as a data source for several studies. 11 , 12 , 13 Comprehensive personally linked data were collected and all individuals were uniquely identified. The dataset includes basic information from the subscriber list (sex, age, zip code, observation period, and reason for disenrollment, including death).…”

Section: Methodsmentioning

confidence: 99%

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Leukotriene antagonists reduce epileptic seizures‐related hospitalization in older adult populations with allergic rhinitis or asthma: A population‐based cohort study using the Shizuoka Kokuho database: The Shizuoka study

Imaichi,

Nakatani,

Fukutomi

et al. 2023

Epilepsia Open

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ObjectiveManaging the risk of epileptic seizures in older adults is increasingly important as the population ages. Leukotriene receptor antagonists (LTRAs) are commonly used to treat asthma or allergic rhinitis. Preclinical studies suggest that LTRAs have antiepileptic effects; however, few population‐based etiological studies on this topic have been available. Our study explored whether LTRAs reduce hospitalization risk associated with epileptic seizure in older individuals with asthma or allergic rhinitis.MethodsWe conducted a new‐user design analysis using the Shizuoka Kokuho database. We included all individuals aged 60–89 years who had at least one episode of allergic rhinitis or asthma during the study period. We compared individuals who newly started LTRAs with those who did not take LTRAs. Propensity score matching was used to balance the baseline characteristics of the participants. We compared the hazard ratios for seizure‐related hospitalization between new LTRA users and non‐users and performed subgroup analyses.ResultsOur matched cohorts consisted of 64,724 new users and non‐users of LTRAs who were aged 60–89 years and had asthma or allergic rhinitis. During the observation period, 377 (0.58%) and 595 (0.92%) incidents were observed in the LTRA new‐user and non‐user groups, respectively. The hazard ratio for seizure‐related hospitalization was 0.75 (95% confidence interval [CI]: 0.62–0.92) in the LTRA new‐user group compared with the non‐user group. Subgroup analysis revealed that the hazard ratio was weak in diabetic patients (1.31; 95% CI: 0.72–2.38).SignificanceThis study indicated that LTRAs reduced seizure‐related hospitalization in older adult patients with allergic rhinitis or asthma. We could not evaluate the severity and related diseases of epileptic seizure during LTRAs. Further studies, including observational studies, detailed multicenter prospective studies, and clinical trials, are needed to validate these findings.

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“…Systemic autoimmune disease is another risk factor for the development of SJS [ 3 , 4 ]. In autoimmune diseases, disturbed regulatory immunity augments cytotoxic reactions, which are associated with the induction of SJS/TEN [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis

Bourke

Cummings

Hurley

et al. 2023

JCM

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Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic disease. We report an unusual presentation of isolated ocular Stevens–Johnson syndrome in a patient with recently diagnosed ulcerative colitis being treated with Infliximab. The case had an insidious and atypical onset and represented a diagnostic dilemma. The diagnosis was more difficult, due to the fact that the inciting agent had long been stopped. Severe bacterial conjunctivitis such as that caused by Chlamydia Trachomatis, Corynebacterium diphtheria, and Neisseria Gonorrhea can cause forniceal shortening and symblepharon; this diagnosis was ruled out with microbiological swabs. A conjunctival biopsy was the key to diagnosis. Treatment involved high-dose IV steroids and dual immunosuppression with Infliximab and mycophenolate mofetil. We sought to employ interventions with the greatest impacts on our patient’s condition. Our experience contributes to the growing evidence supporting intensive ophthalmic management of SJS to prevent long-term vision loss.

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Risk factors and drugs that trigger the onset of Stevens–Johnson syndrome and toxic epidermal necrolysis: A population-based cohort study using the Shizuoka Kokuho database

Cited by 11 publications

References 48 publications

Clinical Characteristics and Treatment of Ophthalmic Sequelae of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Eyecare Centre in Hungary

Clinical Characteristics and Treatment of Ophthalmic Sequelae of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Eyecare Centre in Hungary

Leukotriene antagonists reduce epileptic seizures‐related hospitalization in older adult populations with allergic rhinitis or asthma: A population‐based cohort study using the Shizuoka Kokuho database: The Shizuoka study

Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis

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